Provider Demographics
NPI:1366943516
Name:LAM, REBECCA RANSON
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RANSON
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 GREEN RETIREMENT LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6065
Mailing Address - Country:US
Mailing Address - Phone:804-779-3241
Mailing Address - Fax:
Practice Address - Street 1:8350 GREEN RETIREMENT LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-6065
Practice Address - Country:US
Practice Address - Phone:804-779-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst