Provider Demographics
NPI:1699440503
Name:LIOTTA, RACHEL (RESIDENT IN COUNSELI)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:LIOTTA
Suffix:
Gender:F
Credentials:RESIDENT IN COUNSELI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 DEERFIELD CRES
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2447
Mailing Address - Country:US
Mailing Address - Phone:175-795-6610
Mailing Address - Fax:
Practice Address - Street 1:3217 WESTERN BRANCH BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5235
Practice Address - Country:US
Practice Address - Phone:757-956-6100
Practice Address - Fax:757-956-6101
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA070413018106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070413018OtherRESIDENT IN COUNSELING LICENSE