Basic Information
Provider Information | |||||||||
NPI: | 1598049017 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COWAN | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD, LPC, NCC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCBRIDE | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | GRACE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHD, LPC, NCC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 936 | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235010936 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7573976344 | ||||||||
FaxNumber: | 7576061185 | ||||||||
Practice Location | |||||||||
Address1: | 600 CRAWFORD ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | PORTSMOUTH | ||||||||
State: | VA | ||||||||
PostalCode: | 237043820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7573976344 | ||||||||
FaxNumber: | 7576061185 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2011 | ||||||||
LastUpdateDate: | 12/03/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701005099 | VA | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
ID | Type | State | Issuer | Description | 1598049017 | 01 | VA | OPTIMA BEHAVIOAL HEALTH | OTHER | 1598049017 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1598049017 | 01 | VA | COVENTRY NATIONAL | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | AETNA | OTHER | 1598049017 | 05 | VA |   | MEDICAID | 448660 | 01 | VA | ANTHEM BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | CORVEL | OTHER | -086 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1598049017 | 01 | VA | CIGNA BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | MAGELLAN HEALTH SERVICES | OTHER | 1598049017 | 01 | VA | UNITED BEHAVIORAL HEALTH | OTHER | PAR | 01 | VA | MANAGED HEALTH NETWORK | OTHER |