Provider Demographics
NPI:1902638349
Name:WOODY, RACHEL BURKHART (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:BURKHART
Last Name:WOODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARLENA
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 LOIZOS DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4702
Mailing Address - Country:US
Mailing Address - Phone:704-305-6671
Mailing Address - Fax:
Practice Address - Street 1:118 LOIZOS DR NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4702
Practice Address - Country:US
Practice Address - Phone:704-305-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical