Provider Demographics
NPI:1710792387
Name:WATERS, REBECCA LYNN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WATERS
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 1:568 AVONDALE LN
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7741
Mailing Address - Country:US
Mailing Address - Phone:205-473-5067
Mailing Address - Fax:
Practice Address - Street 1:79001 AL HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AL
Practice Address - Zip Code:35096-4073
Practice Address - Country:US
Practice Address - Phone:256-315-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC05197101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional