Provider Demographics
NPI:1285087031
Name:PENNELL, RACHAEL VAUGHN (MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:VAUGHN
Last Name:PENNELL
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANNE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 MEDICAL PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8702
Mailing Address - Country:US
Mailing Address - Phone:704-316-6561
Mailing Address - Fax:704-384-1977
Practice Address - Street 1:8401 MEDICAL PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8702
Practice Address - Country:US
Practice Address - Phone:704-316-6561
Practice Address - Fax:704-384-1977
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0117621041C0700X
NCP0107101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00550523Medicaid