Provider Demographics
NPI:1265924625
Name:SMITH, RACHEL ALICE (LPCC-S, LCADC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC-S, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ASHGROVE RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9202
Mailing Address - Country:US
Mailing Address - Phone:859-813-0569
Mailing Address - Fax:
Practice Address - Street 1:1115 ASHGROVE RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9202
Practice Address - Country:US
Practice Address - Phone:859-813-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265858101YA0400X
KY243594101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY243594OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR
KY7100552280Medicaid
KY7100552280Medicaid