Provider Demographics
NPI:1528837606
Name:NORMAN, REBECCA ANN BOOTH (MS, CRC, LCMHC-A)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN BOOTH
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MS, CRC, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 COUNTRY TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-6493
Mailing Address - Country:US
Mailing Address - Phone:980-494-0131
Mailing Address - Fax:
Practice Address - Street 1:3628 LEONARD RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8723
Practice Address - Country:US
Practice Address - Phone:980-494-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC631255225C00000X
NCA18839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor