Provider Demographics
NPI:1790759751
Name:BRINK, RACHEL LONG (LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LONG
Last Name:BRINK
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:LONG
Other - Last Name:COLQUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3743 EAGLEFLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4080
Mailing Address - Country:US
Mailing Address - Phone:813-995-2530
Mailing Address - Fax:
Practice Address - Street 1:14517 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE #201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2755
Practice Address - Country:US
Practice Address - Phone:813-228-2761
Practice Address - Fax:813-225-7048
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 57061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical