MEDICARE: RAQUEL HENKEL M.A.,LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5310	NC
2	101YM0800X	Mental Health Counselor	5310	NC

General Provider Information

NPI Number	:	1629160528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL HENKEL M.A.,LCMHC

Provider Business Mailing Address
First Line	:	4475 ASBURY PLACE DR
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-7752
Country	:	US
Telephone Number	:	336-409-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	2530 MERIDIAN PKWY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-5272
Country	:	US
Telephone Number	:	919-646-6643
Fax Number	:	954-480-1784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/04/2024

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