Basic Information
| Provider Information | |||||||||
| NPI: | 1053948919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RACHT | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2527 S 11TH ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491204747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692621815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2527 S 11TH ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NILES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491204747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692621815 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401018223 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101Y00000X | 6401018223 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.