Provider Demographics
NPI:1679013205
Name:MCKEON, RACHEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:MCKEON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:LICKLIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-287-3550
Mailing Address - Fax:804-281-7840
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 311
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-287-3550
Practice Address - Fax:804-281-7840
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040093301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN