Provider Demographics
NPI:1386266468
Name:RAINEY, RACHEL ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-0311
Mailing Address - Country:US
Mailing Address - Phone:706-207-7592
Mailing Address - Fax:
Practice Address - Street 1:1010 1ST ST SE STE 110
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9301
Practice Address - Country:US
Practice Address - Phone:541-347-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL15639104100000X
GACSW0082791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical