Healthcare Provider Details

I. General information

NPI: 1558915702
Provider Name (Legal Business Name): RACHELLE LAMARIS SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 MAGAZINE DRIVE
MECHANICSVILLE VA
23116
US

IV. Provider business mailing address

1912 WEATHERFIELD WAY
RICHMOND VA
23223-2345
US

V. Phone/Fax

Practice location:
  • Phone: 804-779-2356
  • Fax:
Mailing address:
  • Phone: 804-955-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: