Healthcare Provider Details

I. General information

NPI: 1124811765
Provider Name (Legal Business Name): RACHEL ELIZABETH KOLLWITZ LIAC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 CAMPUS DR
SIERRA VISTA AZ
85635-2449
US

IV. Provider business mailing address

1941 N SANDERS RD
HUACHUCA CITY AZ
85616-8101
US

V. Phone/Fax

Practice location:
  • Phone: 520-458-3932
  • Fax:
Mailing address:
  • Phone: 210-803-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15725
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number155363
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: