Provider Demographics
NPI:1023829355
Name:PELLETIER, REBECCA LEE (CSC, MSSC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:CSC, MSSC
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:LEE
Other - Last Name:KANNADAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS IN ESE
Mailing Address - Street 1:640 N NOVA RD APT 201
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4410
Mailing Address - Country:US
Mailing Address - Phone:386-259-0084
Mailing Address - Fax:
Practice Address - Street 1:640 N NOVA RD APT 201
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4410
Practice Address - Country:US
Practice Address - Phone:386-259-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL617479101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool