Provider Demographics
NPI:1447908470
Name:ELLIS, REBECCA WRIGHT (LCMHCA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:WRIGHT
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:WRIGHT
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:3427 MELROSE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:489 HILL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3509
Practice Address - Country:US
Practice Address - Phone:910-214-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17590101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)