Provider Demographics
NPI:1780911784
Name:RAHENKAMP, VICKI JOSEPHINE (LCPC)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:JOSEPHINE
Last Name:RAHENKAMP
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1398
Mailing Address - Country:US
Mailing Address - Phone:410-479-2650
Mailing Address - Fax:833-908-2283
Practice Address - Street 1:808 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1398
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:833-908-2283
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3358101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522156095OtherCOMMERCIAL INS
MD609550002Medicaid
MD609550001Medicaid
MD609550004Medicaid