Provider Demographics
NPI:1669631883
Name:RAWLES & ASSOCIATES, PLC
Entity Type:Organization
Organization Name:RAWLES & ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:DEEN
Authorized Official - Last Name:RAWLES
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:757-493-2912
Mailing Address - Street 1:6022 JEFFERSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-3000
Mailing Address - Country:US
Mailing Address - Phone:757-493-2912
Mailing Address - Fax:757-493-2913
Practice Address - Street 1:6022 JEFFERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3000
Practice Address - Country:US
Practice Address - Phone:757-493-2912
Practice Address - Fax:757-493-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1051Medicare PIN