Basic Information
| Provider Information | |||||||||
| NPI: | 1407312929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROY | ||||||||
| FirstName: | RAQUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 S WASHINGTON AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897934790 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 203 S WASHINGTON AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897934790 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2019 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106S00000X | N | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 6851114683 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.