Healthcare Provider Details

I. General information

NPI: 1417051004
Provider Name (Legal Business Name): ELAINE G. RASCO LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ELAINE GAMEL-RASCO LPC-S

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 CAHABA HEIGHTS CT STE 129
VESTAVIA AL
35243-5741
US

IV. Provider business mailing address

1733 LINTHICUM ST
BIRMINGHAM AL
35217-3214
US

V. Phone/Fax

Practice location:
  • Phone: 205-968-8360
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2177
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: