Provider Demographics
NPI:1568214765
Name:MCKINLEY, RACHEL RAE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RAE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ARDEN RD SW APT A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-2727
Mailing Address - Country:US
Mailing Address - Phone:540-798-6831
Mailing Address - Fax:
Practice Address - Street 1:2149 ELECTRIC RD STE 5
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1975
Practice Address - Country:US
Practice Address - Phone:540-218-2008
Practice Address - Fax:540-900-2689
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0906015105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker