Provider Demographics
NPI:1669184180
Name:WASHINGTON, RACQUEL (TYPE 73)
Entity type:Individual
Prefix:MISS
First Name:RACQUEL
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:TYPE 73
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 NORTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1725
Mailing Address - Country:US
Mailing Address - Phone:980-895-7536
Mailing Address - Fax:
Practice Address - Street 1:4413 NORTHAVEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1725
Practice Address - Country:US
Practice Address - Phone:980-895-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000000000405300000X
NCNA175T00000X, 251K00000X, 374J00000X, 253Z00000X, 174N00000X, 171400000X, 172V00000X
261QB0400X
IL2532823101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
No175T00000XOther Service ProvidersPeer Specialist
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula
No253Z00000XAgenciesIn Home Supportive Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker