Provider Demographics
NPI:1811211691
Name:MICKEL, RACHEL M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:M
Last Name:MICKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 RIVER RD STE 230-824
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2268
Mailing Address - Country:US
Mailing Address - Phone:213-444-7334
Mailing Address - Fax:
Practice Address - Street 1:9135 ARCHIBALD AVE
Practice Address - Street 2:STE B
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5227
Practice Address - Country:US
Practice Address - Phone:213-444-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM7600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker