Provider Demographics
NPI:1700694940
Name:RASNAKE, CAMERON GRACE (LPC-MHSP (T))
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:GRACE
Last Name:RASNAKE
Suffix:
Gender:F
Credentials:LPC-MHSP (T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SHELBY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3680
Mailing Address - Country:US
Mailing Address - Phone:423-516-9166
Mailing Address - Fax:
Practice Address - Street 1:317 SHELBY ST STE 301
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3680
Practice Address - Country:US
Practice Address - Phone:423-516-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional