Provider Demographics
NPI:1649627506
Name:CRISS, RACHEL (MA LPC ALPS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CRISS
Suffix:
Gender:F
Credentials:MA LPC ALPS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:LOGGAINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC CRC
Mailing Address - Street 1:130 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5313
Mailing Address - Country:US
Mailing Address - Phone:304-916-1354
Mailing Address - Fax:304-916-1354
Practice Address - Street 1:130 4TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5313
Practice Address - Country:US
Practice Address - Phone:304-916-1354
Practice Address - Fax:304-916-1354
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1386795516Medicaid