Healthcare Provider Details

I. General information

NPI: 1811144942
Provider Name (Legal Business Name): RACHAEL HOLLISTER WOOTEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 KITTRELL DR.
RALEIGH NC
27608
US

IV. Provider business mailing address

2721 KITTRELL DR.
RALEIGH NC
27608
US

V. Phone/Fax

Practice location:
  • Phone: 919-881-9661
  • Fax: 919-881-1165
Mailing address:
  • Phone: 919-881-9661
  • Fax: 919-881-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number569
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: