Provider Demographics
NPI:1396058400
Name:FORD, RACHEL LYNN (EDS)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LYNN
Last Name:FORD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8936
Mailing Address - Country:US
Mailing Address - Phone:919-616-4026
Mailing Address - Fax:
Practice Address - Street 1:610 W PEACE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1520
Practice Address - Country:US
Practice Address - Phone:919-616-4026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1856103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling