Provider Demographics
NPI:1902624554
Name:GOTTLIEB, RACHEL (SUDPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDPT
Mailing Address - Street 1:8203 BIRCH TERRACE PL
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98240-9416
Mailing Address - Country:US
Mailing Address - Phone:480-353-9026
Mailing Address - Fax:
Practice Address - Street 1:4129 MERIDINA ST. #220
Practice Address - Street 2:
Practice Address - City:BELLIGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-922-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61573007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)