Provider Demographics
NPI:1326792441
Name:LUSCOMBE, RACHAEL
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:LUSCOMBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ARROYO VISTA LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7288
Mailing Address - Country:US
Mailing Address - Phone:203-451-6600
Mailing Address - Fax:
Practice Address - Street 1:101 WAXHAW PROFESSIONAL PARK DR STE D
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0501
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0172141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty