Provider Demographics
NPI:1881306306
Name:ALEQUIN, RACINE (LMHC, MCAP)
Entity type:Individual
Prefix:
First Name:RACINE
Middle Name:
Last Name:ALEQUIN
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12965 PINEFOREST WAY W
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1725
Mailing Address - Country:US
Mailing Address - Phone:727-644-5794
Mailing Address - Fax:
Practice Address - Street 1:28465 US HIGHWAY 19 N STE 200
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2511
Practice Address - Country:US
Practice Address - Phone:727-600-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL.0101061101YA0400X
FLMH20644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)