Healthcare Provider Details

I. General information

NPI: 1780911784
Provider Name (Legal Business Name): VICKI JOSEPHINE RAHENKAMP LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S 5TH AVE
DENTON MD
21629-1398
US

IV. Provider business mailing address

808 S 5TH AVE
DENTON MD
21629-1398
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-2650
  • Fax: 833-908-2283
Mailing address:
  • Phone: 410-479-2650
  • Fax: 833-908-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3358
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: