Healthcare Provider Details

I. General information

NPI: 1952268641
Provider Name (Legal Business Name): RAQUEL ITALIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAQUEL WHITE SALVADOR ITALIA IT, MA, LLPC

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/O HEART WALK COUNSELING 5242 PLAINFIELD AVENUE NE - SUITE F
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

34149 LITTLE MACK AVE
CLINTON TOWNSHIP MI
48035-3497
US

V. Phone/Fax

Practice location:
  • Phone: 248-602-2014
  • Fax:
Mailing address:
  • Phone: 248-602-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023848
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: