Provider Demographics
NPI:1407541311
Name:KNIGHT, RACQUEL ANNETTE (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:ANNETTE
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 OXHORN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4116
Mailing Address - Country:US
Mailing Address - Phone:443-758-5957
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2680
Practice Address - Country:US
Practice Address - Phone:443-758-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3464011171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty