Provider Demographics
NPI:1275074379
Name:PACKER, RACHEL GABRIELLE (LPCC)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:GABRIELLE
Last Name:PACKER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501991
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1991
Mailing Address - Country:US
Mailing Address - Phone:856-979-6733
Mailing Address - Fax:
Practice Address - Street 1:3760 HERMAN AVE APT 6
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3749
Practice Address - Country:US
Practice Address - Phone:856-979-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional