Provider Demographics
NPI:1194554782
Name:RAKAY, ASHLEY DEVON
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEVON
Last Name:RAKAY
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 1:1212 E FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3504
Mailing Address - Country:US
Mailing Address - Phone:201-240-8207
Mailing Address - Fax:
Practice Address - Street 1:1212 E FLETCHER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3504
Practice Address - Country:US
Practice Address - Phone:201-240-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional