Provider Demographics
NPI:1396562237
Name:CHICKVARA, RACHEL LYN (ALC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYN
Last Name:CHICKVARA
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYN
Other - Last Name:BERNHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 CAHABA RIVER PARC
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3267
Mailing Address - Country:US
Mailing Address - Phone:228-236-5126
Mailing Address - Fax:
Practice Address - Street 1:701 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1847
Practice Address - Country:US
Practice Address - Phone:205-916-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health