Provider Demographics
NPI:1730678285
Name:WIEDER, RACHEL FRANCES (LGPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:FRANCES
Last Name:WIEDER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:FRANCES
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1122 KENILWORTH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2141
Mailing Address - Country:US
Mailing Address - Phone:443-841-7785
Mailing Address - Fax:
Practice Address - Street 1:1122 KENILWORTH DR STE 105
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2141
Practice Address - Country:US
Practice Address - Phone:443-841-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health