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General NPI Number Information
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NPI Number | 1952268641
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Entity Type | Individual
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Provider Name | RAQUEL ITALIA
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Gender | Female
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | C/O HEART WALK COUNSELING 5242 PLAINFIELD AVENUE NE - SUITE F
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 248-602-2014
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Fax |
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Provider Business Mailing Address
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Address Line | 34149 LITTLE MACK AVE
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-3497
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Country | US
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Telephone | 248-602-2014
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451023848
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451023848
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License Number State | MI
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