Provider Demographics
NPI:1730791682
Name:RACITI, GINA (PHD, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:RACITI
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-0533
Mailing Address - Country:US
Mailing Address - Phone:302-219-0953
Mailing Address - Fax:
Practice Address - Street 1:317 HICKMAN ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-1854
Practice Address - Country:US
Practice Address - Phone:302-219-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4615101YP2500X
MD05980103TC0700X
DEB1-0011316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional