Healthcare Provider Details

I. General information

NPI: 1265981633
Provider Name (Legal Business Name): RACHEL J WAGERS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL VARGAS LPCA

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOME RD
COVINGTON KY
41011-1942
US

IV. Provider business mailing address

75 CAVALIER BLVD STE. 110
FLORENCE KY
41042-3950
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-8768
  • Fax: 859-291-2431
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number170499
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number247209
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: