Provider Demographics
NPI:1689171373
Name:DE METZ, RACHEL CONSTANCE (CAC, CET)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:CONSTANCE
Last Name:DE METZ
Suffix:
Gender:F
Credentials:CAC, CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 NE 57TH PL
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-6120
Mailing Address - Country:US
Mailing Address - Phone:954-934-8959
Mailing Address - Fax:
Practice Address - Street 1:3601 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3300
Practice Address - Country:US
Practice Address - Phone:954-934-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)