Healthcare Provider Details

I. General information

NPI: 1083699011
Provider Name (Legal Business Name): RICHARD CARTER RAWLINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK RAWLINS LCSW

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

IV. Provider business mailing address

140 SOUTH HOLLY STREET
MEDFORD OR
97501
US

V. Phone/Fax

Practice location:
  • Phone: 541-774-8200
  • Fax: 541-774-7964
Mailing address:
  • Phone: 541-774-8200
  • Fax: 541-774-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2952733501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: