Provider Demographics
NPI:1710487129
Name:CARTER, RACHEL MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2540 N TALMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2055 W ARMY TRAIL RD STE 140
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1478
Practice Address - Country:US
Practice Address - Phone:312-229-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0144301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical