Provider Demographics
NPI:1194171082
Name:HAZEL, RACHELE CHRISTINA
Entity type:Individual
Prefix:MRS
First Name:RACHELE
Middle Name:CHRISTINA
Last Name:HAZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHELE
Other - Middle Name:CHRISTINA
Other - Last Name:HAZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11200 E STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9308
Mailing Address - Country:US
Mailing Address - Phone:810-869-9702
Mailing Address - Fax:
Practice Address - Street 1:2700 ROBERT T LONGWAY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2190
Practice Address - Country:US
Practice Address - Phone:810-496-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor