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General NPI Number Information
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NPI Number | 1659801934
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Entity Type | Organization
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Legal Business Name | RACHEL TEAGLE
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 17389 PARHAM LANDING CT STE 10
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City | WEST POINT
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State | VA
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Zip | 23181-9488
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Country | US
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Telephone | 757-298-4963
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Fax | 800-613-9112
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Provider Business Mailing Address
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Address Line | 7364 LEWIS AVE
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City | GLOUCESTER
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State | VA
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Zip | 23061-5184
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Country | US
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Telephone | 757-298-4963
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Fax | 800-613-9112
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | RACHEL TEAGLE
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Credential | LPC
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Telephone | 757-298-4963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701004462
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License Number State | VA
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