Provider Demographics
NPI:1881441475
Name:DOMENICK, RACHEL MARIE (MS CMHC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:DOMENICK
Suffix:
Gender:F
Credentials:MS CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 FOULK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3641
Mailing Address - Country:US
Mailing Address - Phone:302-307-6892
Mailing Address - Fax:
Practice Address - Street 1:2004 FOULK RD STE 3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3641
Practice Address - Country:US
Practice Address - Phone:302-307-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health