Provider Demographics
NPI:1114628369
Name:KITCHENS-COLE, RACHEL CALYSTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:CALYSTA
Last Name:KITCHENS-COLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 WOODROW DR # A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2326
Mailing Address - Country:US
Mailing Address - Phone:404-593-7647
Mailing Address - Fax:
Practice Address - Street 1:590 WOODROW DR # A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2326
Practice Address - Country:US
Practice Address - Phone:404-593-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005759101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health