Provider Demographics
NPI:1417464603
Name:SCROGGIN, RACHAEL NICOLE (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:SCROGGIN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:NICOLE
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5504 WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8114
Mailing Address - Country:US
Mailing Address - Phone:757-603-4603
Mailing Address - Fax:757-250-3657
Practice Address - Street 1:5248 OLDE TOWNE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1986
Practice Address - Country:US
Practice Address - Phone:757-603-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3372621Medicaid