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General NPI Number Information
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NPI Number | 1770309387
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Entity Type | Organization
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Legal Business Name | GEORGIA RAE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 2435 KIMBERLY RD STE 25N
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City | BETTENDORF
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State | IA
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Zip | 52722-3507
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Country | US
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Telephone | 563-396-2625
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Fax | 563-296-8989
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Provider Business Mailing Address
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Address Line | 2435 KIMBERLY RD STE 25N
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City | BETTENDORF
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State | IA
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Zip | 52722-3507
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Country | US
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Telephone | 563-396-2625
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Fax | 563-296-8989
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | LAUREL VANKLAVEREN
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Credential | PSYD, LMHC, LCPC
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Telephone | 563-396-2625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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