Individual
RACQUEL T ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5010 W BROAD ST APT 3407, SUGAR HILL, GA 30518-4219
(843) 929-7805
Mailing address
5010 W BROAD ST APT 3407, SUGAR HILL, GA 30518-4219
(843) 929-7805
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
423105203638
—
NC
Enumeration date
04/23/2021
Last updated
04/23/2021
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