Provider Demographics
NPI:1659801934
Name:RACHEL TEAGLE
Entity Type:Organization
Organization Name:RACHEL TEAGLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-298-4963
Mailing Address - Street 1:7364 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-5184
Mailing Address - Country:US
Mailing Address - Phone:757-298-4963
Mailing Address - Fax:800-613-9112
Practice Address - Street 1:17389 PARHAM LANDING CT STE 10
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-9488
Practice Address - Country:US
Practice Address - Phone:757-298-4963
Practice Address - Fax:800-613-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004462251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health