Provider Demographics
NPI:1073875035
Name:RAINE, GEOFFREY SIEGEL (LCSW)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:SIEGEL
Last Name:RAINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-398-3601
Mailing Address - Fax:828-333-5465
Practice Address - Street 1:125 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-398-3601
Practice Address - Fax:828-333-5465
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091391041C0700X, 1041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical