Provider Demographics
NPI:1093726176
Name:RHODES WITTICH, CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:RHODES WITTICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:RHODES WITTICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7522
Mailing Address - Country:US
Mailing Address - Phone:916-844-4601
Mailing Address - Fax:
Practice Address - Street 1:4115 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7522
Practice Address - Country:US
Practice Address - Phone:916-844-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS51361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78370ZMedicare PIN