Provider Demographics
NPI:1053592402
Name:AINSLEY, RACHAEL GUINEVERE (MA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:GUINEVERE
Last Name:AINSLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PALMETTO PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7872
Mailing Address - Country:US
Mailing Address - Phone:803-996-1500
Mailing Address - Fax:803-996-1511
Practice Address - Street 1:120 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:BATESBURG
Practice Address - State:SC
Practice Address - Zip Code:29006-2107
Practice Address - Country:US
Practice Address - Phone:803-532-8414
Practice Address - Fax:803-532-4570
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC322842 SCMedicaid
SC322842 SCMedicaid