Provider Demographics
NPI:1679549810
Name:RACHEOTES, CAROL K
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:K
Last Name:RACHEOTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2664
Mailing Address - Country:US
Mailing Address - Phone:903-791-1051
Mailing Address - Fax:903-791-1054
Practice Address - Street 1:5221 N PARK RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2664
Practice Address - Country:US
Practice Address - Phone:903-791-1051
Practice Address - Fax:903-791-1054
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10493101YM0800X
ARP9204008101YM0800X
TX003155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist