Provider Demographics
NPI:1013404383
Name:RAINWOOD COUNSELING LLC
Entity Type:Organization
Organization Name:RAINWOOD COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-220-4789
Mailing Address - Street 1:540 WATER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6378
Mailing Address - Country:US
Mailing Address - Phone:907-220-4789
Mailing Address - Fax:800-215-6101
Practice Address - Street 1:540 WATER ST STE 202
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6378
Practice Address - Country:US
Practice Address - Phone:907-220-4789
Practice Address - Fax:800-215-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-22
Last Update Date:2018-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1107091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty