Provider Demographics
NPI:1215533476
Name:COOKSEY, RACHELLE (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18316 RINGGOLD SOUTHERN RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9252
Mailing Address - Country:US
Mailing Address - Phone:330-814-7589
Mailing Address - Fax:
Practice Address - Street 1:18316 RINGGOLD SOUTHERN RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9252
Practice Address - Country:US
Practice Address - Phone:330-814-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17003301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty