Provider Demographics
NPI:1649008152
Name:GLASS, RACHEL SUZANNE (ALC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUZANNE
Last Name:GLASS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SUZANNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 SLEDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3000
Mailing Address - Country:US
Mailing Address - Phone:251-473-3410
Mailing Address - Fax:251-476-4454
Practice Address - Street 1:22765 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3499
Practice Address - Country:US
Practice Address - Phone:251-473-3410
Practice Address - Fax:251-476-4454
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty