Provider Demographics
NPI:1316108707
Name:STAPLES, REBECCA SUSAN (MS/EDS, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUSAN
Last Name:STAPLES
Suffix:
Gender:F
Credentials:MS/EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRIAR RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4912
Mailing Address - Country:US
Mailing Address - Phone:336-430-0599
Mailing Address - Fax:
Practice Address - Street 1:2504 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4522
Practice Address - Country:US
Practice Address - Phone:336-544-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6498101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor