Provider Demographics
NPI:1033181557
Name:YODER, REBECCA T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:T
Last Name:YODER
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 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1907
Mailing Address - Fax:
Practice Address - Street 1:172 S CLEMENT ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2336
Practice Address - Country:US
Practice Address - Phone:252-744-8334
Practice Address - Fax:252-744-8335
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138CTOtherBCBS NC
NC1033181557Medicaid
NCP00022787OtherRAILROAD MEDICARE
NC2876298BMedicare PIN