Provider Demographics
NPI:1619387297
Name:KILGORE, RACHEL (MED,NCC, LPCA, LCASA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MED,NCC, LPCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7903
Mailing Address - Country:US
Mailing Address - Phone:704-649-1025
Mailing Address - Fax:
Practice Address - Street 1:2425 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7903
Practice Address - Country:US
Practice Address - Phone:704-649-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10748101YM0800X
NCA20282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)