Provider Demographics
NPI:1043551724
Name:DAVIS, RHONDA DARLENE (CG60317026)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:DARLENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CG60317026
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209WHOLLYST..
Mailing Address - Street 2:209WHOLLYST.
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4311
Mailing Address - Country:US
Mailing Address - Phone:360-325-1984
Mailing Address - Fax:
Practice Address - Street 1:209WHOLLYST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-325-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60317026101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health