Provider Demographics
NPI:1023561636
Name:MATHIS, RHONDA (ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 W 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2063
Mailing Address - Country:US
Mailing Address - Phone:908-636-4049
Mailing Address - Fax:
Practice Address - Street 1:630 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1414
Practice Address - Country:US
Practice Address - Phone:908-636-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14-104221700000X
NJ37PC00698900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist