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General NPI Number Information
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NPI Number | 1215379185
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Entity Type | Individual
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Provider Name | RACHEL FOWKE LCSW LMSW CSAC CAADC
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16950 19 MILE RD STE 3H
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City | CLINTON TWP
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State | MI
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Zip | 48038-4806
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Country | US
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Telephone | 586-651-9324
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Fax | 833-843-7621
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Provider Business Mailing Address
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Address Line | PO BOX 232
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City | ROMEO
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State | MI
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Zip | 48065-0232
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Country | US
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Telephone | 586-651-9324
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Fax | 833-843-7621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-4130
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094943
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License Number State | MI
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