Healthcare Provider Details

I. General information

NPI: 1003642745
Provider Name (Legal Business Name): RAKEMA BOOKER-WARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE
MIAMI FL
33136-1104
US

IV. Provider business mailing address

415 N 2ND AVE
MAYWOOD IL
60153-1107
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020435
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: