Provider Demographics
NPI:1972742690
Name:WARD, RACQUEL DELYTE (LCAS, LCSWA)
Entity type:Individual
Prefix:MS
First Name:RACQUEL
Middle Name:DELYTE
Last Name:WARD
Suffix:
Gender:F
Credentials:LCAS, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4003
Mailing Address - Country:US
Mailing Address - Phone:704-370-3227
Mailing Address - Fax:704-370-3377
Practice Address - Street 1:1123 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4003
Practice Address - Country:US
Practice Address - Phone:704-370-3227
Practice Address - Fax:704-370-3377
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0104011041C0700X
NC1619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical