Provider Demographics
NPI:1134874712
Name:CREQUE, RAYSA E (LCPC)
Entity type:Individual
Prefix:
First Name:RAYSA
Middle Name:E
Last Name:CREQUE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 FLOWER AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6640
Mailing Address - Country:US
Mailing Address - Phone:201-306-5749
Mailing Address - Fax:
Practice Address - Street 1:8508 FLOWER AVE APT 1A
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6640
Practice Address - Country:US
Practice Address - Phone:201-306-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC12174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health