Provider Demographics
NPI:1326887514
Name:DE VILLE, REBECCA WREN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WREN
Last Name:DE VILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 RENAULT PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2622
Mailing Address - Country:US
Mailing Address - Phone:703-864-1377
Mailing Address - Fax:
Practice Address - Street 1:2100 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3910
Practice Address - Country:US
Practice Address - Phone:703-506-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health