MEDICARE: RACHAEL DAWN DUDLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	CSW003632	GA

General Provider Information

NPI Number	:	1235100348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL DAWN DUDLEY LCSW

Provider Business Mailing Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-1500
Country	:	US
Telephone Number	:	229-257-1459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3278 MITCHELL BLVD
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-6865
Country	:	US
Telephone Number	:	229-262-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	07/29/2025

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