Provider Demographics
NPI:1134436538
Name:JORGENSON, REBECCA (MA, LPCA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 JONES FRANKLIN ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3351
Mailing Address - Country:US
Mailing Address - Phone:919-851-1527
Mailing Address - Fax:919-851-3555
Practice Address - Street 1:1215 JONES FRANKLIN ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3351
Practice Address - Country:US
Practice Address - Phone:919-851-1527
Practice Address - Fax:919-851-3555
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional