Provider Demographics
NPI:1033307251
Name:ADDO, RAYCHELLE HARPER (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYCHELLE
Middle Name:HARPER
Last Name:ADDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAYCHELLE
Other - Middle Name:MARIE-LYNAE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11201 BENTON ST
Mailing Address - Street 2:LOMA LINDA
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92357-1000
Mailing Address - Country:US
Mailing Address - Phone:951-398-8410
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:LOMA LINDA
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:951-398-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 242891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical