Provider Demographics
NPI:1619674272
Name:LUSTFELDT, RACHAEL LAUREN (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LAUREN
Last Name:LUSTFELDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7405
Mailing Address - Country:US
Mailing Address - Phone:229-740-5853
Mailing Address - Fax:
Practice Address - Street 1:2263 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7316
Practice Address - Country:US
Practice Address - Phone:229-433-7000
Practice Address - Fax:229-433-7003
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0083861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical