Provider Demographics
NPI:1881286466
Name:GERSON, RACHEL (MA, LLPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GERSON
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 SIGNATURE BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6473
Mailing Address - Country:US
Mailing Address - Phone:310-889-8425
Mailing Address - Fax:
Practice Address - Street 1:3280 PACKARD ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-413-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional