Healthcare Provider Details

I. General information

NPI: 1992425904
Provider Name (Legal Business Name): RACHEL SIMONE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 INDIAN HILLS DR
RYDAL GA
30171-1658
US

IV. Provider business mailing address

78 INDIAN HILLS DR
RYDAL GA
30171-1658
US

V. Phone/Fax

Practice location:
  • Phone: 470-529-8451
  • Fax:
Mailing address:
  • Phone: 470-529-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: