Provider Demographics
NPI:1144628058
Name:OUTLAND, RAQUEL
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:OUTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 WINDY HILL RD SE UNIT 1971
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-3034
Mailing Address - Country:US
Mailing Address - Phone:770-900-5588
Mailing Address - Fax:
Practice Address - Street 1:1820 THE EXCHANGE SE STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2018
Practice Address - Country:US
Practice Address - Phone:470-400-5913
Practice Address - Fax:770-800-8137
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6813101YP2500X
GALPC0006813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional