Healthcare Provider Details

I. General information

NPI: 1770309387
Provider Name (Legal Business Name): GEORGIA RAE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 KIMBERLY RD STE 25N
BETTENDORF IA
52722-3507
US

IV. Provider business mailing address

2435 KIMBERLY RD STE 25N
BETTENDORF IA
52722-3507
US

V. Phone/Fax

Practice location:
  • Phone: 563-396-2625
  • Fax: 563-296-8989
Mailing address:
  • Phone: 563-396-2625
  • Fax: 563-296-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREL VANKLAVEREN
Title or Position: OWNER AND THERAPIST
Credential: PSYD, LMHC, LCPC
Phone: 563-396-2625