Healthcare Provider Details

I. General information

NPI: 1043696743
Provider Name (Legal Business Name): ELAINE G. RASCO, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 CAHABA HEIGHTS CT STE 190
VESTAVIA AL
35243-5711
US

IV. Provider business mailing address

1733 LINTHICUM ST
BIRMINGHAM AL
35217-3214
US

V. Phone/Fax

Practice location:
  • Phone: 205-253-6520
  • Fax: 205-259-1626
Mailing address:
  • Phone: 205-253-6520
  • Fax: 205-259-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2177
License Number StateAL

VIII. Authorized Official

Name: MS. MARY ELAINE GAMEL-RASCO
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.DIV., M.ED
Phone: 205-253-6520