Provider Demographics
NPI:1861894073
Name:KELLEHER, RACHAEL TERESA (MS)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:TERESA
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MS
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 26170
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-6170
Mailing Address - Country:US
Mailing Address - Phone:336-334-5662
Mailing Address - Fax:336-334-5754
Practice Address - Street 1:1100 W MARKET ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1830
Practice Address - Country:US
Practice Address - Phone:336-334-5662
Practice Address - Fax:336-334-5754
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical