Provider Demographics
NPI:1992335301
Name:KREUTNER, REBECCA KAY (LPC/S, LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:KREUTNER
Suffix:
Gender:F
Credentials:LPC/S, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LONGBRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5468
Mailing Address - Country:US
Mailing Address - Phone:843-327-9820
Mailing Address - Fax:
Practice Address - Street 1:3 BROAD ST STE 205
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3054
Practice Address - Country:US
Practice Address - Phone:843-327-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional