Provider Demographics
NPI:1285960096
Name:CLARK, REBEKAH (LPC)
Entity type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 N MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-2021
Mailing Address - Country:US
Mailing Address - Phone:334-356-0381
Mailing Address - Fax:
Practice Address - Street 1:867 N MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-2021
Practice Address - Country:US
Practice Address - Phone:334-356-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2718101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor