Provider Demographics
NPI:1053983643
Name:MACHACEK, RACHEL SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUSAN
Last Name:MACHACEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 FENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2612
Mailing Address - Country:US
Mailing Address - Phone:202-549-0171
Mailing Address - Fax:
Practice Address - Street 1:2405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4448
Practice Address - Country:US
Practice Address - Phone:804-930-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040130571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical