Provider Demographics
NPI:1992430391
Name:MEHALEK, REBECCA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:MEHALEK
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 1:369 TROUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-9321
Mailing Address - Country:US
Mailing Address - Phone:215-820-9363
Mailing Address - Fax:
Practice Address - Street 1:1400 WILLOW LN
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3551
Practice Address - Country:US
Practice Address - Phone:336-667-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMEHA-6XYJZM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health