Provider Demographics
NPI:1932833506
Name:GREGORY, RAQUEL ANGELIQUE (PSYCHOLOGY ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANGELIQUE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PSYCHOLOGY ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BENFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2639
Mailing Address - Country:US
Mailing Address - Phone:443-600-2663
Mailing Address - Fax:
Practice Address - Street 1:1110 BENFIELD BLVD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2639
Practice Address - Country:US
Practice Address - Phone:443-600-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health