Provider Demographics
NPI:1992130900
Name:HANSOM, REBECKAH (LCSW)
Entity type:Individual
Prefix:
First Name:REBECKAH
Middle Name:
Last Name:HANSOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBECKAH
Other - Middle Name:
Other - Last Name:GOOLSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3130
Mailing Address - Country:US
Mailing Address - Phone:719-284-6563
Mailing Address - Fax:719-447-4794
Practice Address - Street 1:115 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-284-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical