Healthcare Provider Details

I. General information

NPI: 1609112945
Provider Name (Legal Business Name): RACHEL DUNNING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

IV. Provider business mailing address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-1264
  • Fax:
Mailing address:
  • Phone: 704-366-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number7777
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: