Provider Demographics
NPI:1699781856
Name:DOUGLAS-BORELL, RACHELLE ANNE (LPCC-S)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ANNE
Last Name:DOUGLAS-BORELL
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 WEATHERFIELD CT STE 1B
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9149
Mailing Address - Country:US
Mailing Address - Phone:419-866-2830
Mailing Address - Fax:419-866-2831
Practice Address - Street 1:6450 WEATHERFIELD CT
Practice Address - Street 2:STE. 1B
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9146
Practice Address - Country:US
Practice Address - Phone:419-866-2830
Practice Address - Fax:419-866-2831
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4002101YA0400X, 101Y00000X
OHLICDC964551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1699781856Medicaid