Provider Demographics
NPI:1518632629
Name:COUNTRYMAN, REBEKAH MARIE (MA, LPC, LAC, AADC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MARIE
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:MA, LPC, LAC, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 DIANA ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6401
Mailing Address - Country:US
Mailing Address - Phone:228-239-7067
Mailing Address - Fax:
Practice Address - Street 1:261 CALHOUN ST STE 250
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1371
Practice Address - Country:US
Practice Address - Phone:843-867-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC535101YA0400X
SC8270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)