Healthcare Provider Details

I. General information

NPI: 1710487129
Provider Name (Legal Business Name): RACHEL MARIE CARTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. RACHEL MARIE HINES

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W ARMY TRAIL RD STE 140
ADDISON IL
60101-1478
US

IV. Provider business mailing address

2540 N TALMAN AVE
CHICAGO IL
60647-1812
US

V. Phone/Fax

Practice location:
  • Phone: 312-229-7247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014430
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: