Provider Demographics
NPI:1649766817
Name:WHITEHOUSE, RAKILLY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RAKILLY
Middle Name:
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 LAKE PARK DR SE APT J
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4080
Mailing Address - Country:US
Mailing Address - Phone:909-557-5119
Mailing Address - Fax:
Practice Address - Street 1:2167 LAKE PARK DR SE APT J
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4080
Practice Address - Country:US
Practice Address - Phone:909-557-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker