Provider Demographics
NPI:1407221310
Name:SHAH, RACHANA (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 CLIFF CAMERON DR STE 152
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8526
Mailing Address - Country:US
Mailing Address - Phone:704-510-5600
Mailing Address - Fax:
Practice Address - Street 1:8604 CLIFF CAMERON DR STE 152
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8526
Practice Address - Country:US
Practice Address - Phone:704-510-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090231041C0700X
NCC0106221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical