Provider Demographics
NPI:1740789189
Name:DEMETROULES, RACHELLEE (LISW)
Entity Type:Individual
Prefix:
First Name:RACHELLEE
Middle Name:
Last Name:DEMETROULES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4696 GALLIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-8600
Mailing Address - Country:US
Mailing Address - Phone:740-646-2287
Mailing Address - Fax:
Practice Address - Street 1:4696 GALLIA PIKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-8600
Practice Address - Country:US
Practice Address - Phone:740-354-9026
Practice Address - Fax:740-354-9076
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2304821104100000X
OHTRAINING104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker