Provider Demographics
NPI:1902151756
Name:MICHI, RACHEL LAUREN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LAUREN
Last Name:MICHI
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CLAYBURNE DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3493
Mailing Address - Country:US
Mailing Address - Phone:843-327-9882
Mailing Address - Fax:
Practice Address - Street 1:322 CLAYBURNE DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3493
Practice Address - Country:US
Practice Address - Phone:843-327-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-11777103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst