Provider Demographics
NPI:1417566613
Name:KYLE, REBECCA ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:KYLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SCALYBARK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1264
Mailing Address - Country:US
Mailing Address - Phone:803-767-5116
Mailing Address - Fax:
Practice Address - Street 1:311 W MAIN ST STE 408
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3215
Practice Address - Country:US
Practice Address - Phone:919-205-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0112011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical