Provider Demographics
NPI:1699501023
Name:SMITH, RACHAEL (LMHC, ATR)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 130TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2527
Mailing Address - Country:US
Mailing Address - Phone:757-348-5805
Mailing Address - Fax:
Practice Address - Street 1:9110 130TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2527
Practice Address - Country:US
Practice Address - Phone:757-348-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13407101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor