Provider Demographics
NPI:1376728741
Name:PRIEBE, RACHEL DAWN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DAWN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CONOWINGO
Mailing Address - State:MD
Mailing Address - Zip Code:21918-0099
Mailing Address - Country:US
Mailing Address - Phone:103-789-6964
Mailing Address - Fax:410-378-9922
Practice Address - Street 1:49 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONOWINGO
Practice Address - State:MD
Practice Address - Zip Code:21918-1352
Practice Address - Country:US
Practice Address - Phone:410-378-9696
Practice Address - Fax:410-378-9922
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical