Provider Demographics
NPI:1780810556
Name:TENNAL, RAQUEL COX (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:COX
Last Name:TENNAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 OVERBROOK DR
Mailing Address - Street 2:H-3
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1058
Mailing Address - Country:US
Mailing Address - Phone:864-838-2050
Mailing Address - Fax:704-319-9223
Practice Address - Street 1:311 N YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2374
Practice Address - Country:US
Practice Address - Phone:864-838-2050
Practice Address - Fax:704-319-9223
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional