Provider Demographics
NPI:1023907086
Name:BLASSINGAME, RAQUEL MARY
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MARY
Last Name:BLASSINGAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOLENE
Other - Middle Name:LYSARA
Other - Last Name:STARCHILD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:511 N LINCOLN ST STE 31
Mailing Address - Street 2:
Mailing Address - City:HIGH SHOALS
Mailing Address - State:NC
Mailing Address - Zip Code:28077-9700
Mailing Address - Country:US
Mailing Address - Phone:704-601-2646
Mailing Address - Fax:704-240-3393
Practice Address - Street 1:121 W MAIN AVE STE 302
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4154
Practice Address - Country:US
Practice Address - Phone:704-601-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator