Provider Demographics
NPI:1396830923
Name:DAVIS, RACHAEL LUCILLE (LPCC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LUCILLE
Last Name:DAVIS
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 1:6717 MESA MARIPOSA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3357
Mailing Address - Country:US
Mailing Address - Phone:505-315-4680
Mailing Address - Fax:505-867-3514
Practice Address - Street 1:4321 FULCRUM WAY NE STE B
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8410
Practice Address - Country:US
Practice Address - Phone:505-771-5397
Practice Address - Fax:505-867-3514
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMHC: 0082641101Y00000X
NMCCMH0213141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39173097Medicaid