Provider Demographics
NPI:1679148035
Name:MACAULAY, RAQUEL (LPCC)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MACAULAY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:M.
Other - Middle Name:RAQUEL
Other - Last Name:MACAULAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:4010 DUPONT CIR STE 419
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4837
Mailing Address - Country:US
Mailing Address - Phone:502-409-6993
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 419
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4837
Practice Address - Country:US
Practice Address - Phone:502-409-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY269450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health