Provider Demographics
NPI:1962193318
Name:MEACHAM, REBECCA WITT (MA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WITT
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:WITT
Other - Last Name:MEACHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:109 GRACIE DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1860
Mailing Address - Country:US
Mailing Address - Phone:740-738-2113
Mailing Address - Fax:
Practice Address - Street 1:208 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:26074-1082
Practice Address - Country:US
Practice Address - Phone:304-336-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical