Healthcare Provider Details

I. General information

NPI: 1013378959
Provider Name (Legal Business Name): RAQUEL COALE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE SUITE 100
GAITHERSBURG MD
20877-5321
US

IV. Provider business mailing address

407 CARL ST STE 100
ROCKVILLE MD
20851-1142
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3200
  • Fax:
Mailing address:
  • Phone: 240-506-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP6881
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: