Provider Demographics
NPI:1598241200
Name:GWIN, RACHEL CHRISTINE (PHD, BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CHRISTINE
Last Name:GWIN
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14931 ROTHWELL DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-4576
Mailing Address - Country:US
Mailing Address - Phone:609-213-2816
Mailing Address - Fax:
Practice Address - Street 1:14931 ROTHWELL DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-4576
Practice Address - Country:US
Practice Address - Phone:609-213-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-13-13012103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst