Provider Demographics
NPI:1639956261
Name:BOLICK, RACHEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BOLICK
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 1:3687 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4610
Mailing Address - Country:US
Mailing Address - Phone:901-493-9860
Mailing Address - Fax:
Practice Address - Street 1:6551 STAGE OAKS DR STE 4
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3895
Practice Address - Country:US
Practice Address - Phone:901-387-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical