Provider Demographics
NPI:1962759563
Name:CHANG, RAQUEL A (MFT)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:A
Last Name:CHANG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:RAQUEL
Other - Middle Name:A
Other - Last Name:RICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 PU'UHONU WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-969-9994
Mailing Address - Fax:808-969-7570
Practice Address - Street 1:135 PU'UHONU WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-969-9994
Practice Address - Fax:808-969-7570
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist