Healthcare Provider Details

I. General information

NPI: 1154967305
Provider Name (Legal Business Name): RACHEL TEAGLE LPC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17389 PARHAM LANDING CT STE 10
WEST POINT VA
23181-9488
US

IV. Provider business mailing address

7364 LEWIS AVE
GLOUCESTER VA
23061-5184
US

V. Phone/Fax

Practice location:
  • Phone: 804-843-7164
  • Fax:
Mailing address:
  • Phone: 757-298-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHEL K TEAGLE
Title or Position: DIRECTOR
Credential: LPC
Phone: 757-298-4963