Provider Demographics
NPI:1609645845
Name:UGRINOVSKY, RACHEL (ADC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:UGRINOVSKY
Suffix:
Gender:F
Credentials:ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 AZURE LN UNIT 33201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8124
Mailing Address - Country:US
Mailing Address - Phone:201-317-4128
Mailing Address - Fax:
Practice Address - Street 1:2470 MALL DR STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6514
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-2243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty