Healthcare Provider Details

I. General information

NPI: 1689994832
Provider Name (Legal Business Name): RACHEL DILLICKRAETH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 CONROY WINDERMERE RD STE 203
ORLANDO FL
32835-2688
US

IV. Provider business mailing address

7601 CONROY WINDERMERE RD STE 203
ORLANDO FL
32835-2688
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-1461
  • Fax: 407-704-1501
Mailing address:
  • Phone: 407-704-1461
  • Fax: 407-704-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: