Provider Demographics
NPI:1366334153
Name:MOORE, REBBA A (LPC-R)
Entity type:Individual
Prefix:
First Name:REBBA
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 TUNLAW RD NW APT 1004
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4845
Mailing Address - Country:US
Mailing Address - Phone:651-323-7841
Mailing Address - Fax:
Practice Address - Street 1:4250 FAIRFAX DR STE 600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1665
Practice Address - Country:US
Practice Address - Phone:240-748-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016456101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional