Provider Demographics
NPI:1437718988
Name:WARANCH, REBECCA TRACY (LCSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:TRACY
Last Name:WARANCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E PLUME ST STE 327B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1757
Mailing Address - Country:US
Mailing Address - Phone:757-637-0840
Mailing Address - Fax:
Practice Address - Street 1:208 E PLUME ST STE 327B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1757
Practice Address - Country:US
Practice Address - Phone:757-637-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040103721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty