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General NPI Number Information
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NPI Number | 1326108648
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Entity Type | Individual
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Provider Name | DAVID RAQUE PH.D
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11B LENOX POINTE NE
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City | ATLANTA
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State | GA
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Zip | 30324-3171
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Country | US
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Telephone | 706-455-2492
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Fax | 706-492-5714
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | MINERAL BLUFF
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State | GA
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Zip | 30559-0429
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Country | US
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Telephone | 706-455-2492
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Fax | 704-492-5714
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY000413
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY000413
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License Number State | GA
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