Provider Demographics
NPI:1255684049
Name:CLARY, RACHEL RENE (LCSWA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENE
Last Name:CLARY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 EXPRESS DR
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-6501
Mailing Address - Country:US
Mailing Address - Phone:910-755-5222
Mailing Address - Fax:910-755-5255
Practice Address - Street 1:3640 EXPRESS DR
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-6501
Practice Address - Country:US
Practice Address - Phone:910-755-5222
Practice Address - Fax:910-755-5255
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health