Provider Demographics
NPI:1144614652
Name:DICKENS, RHONDA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 AVEBURY DR APT K
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3164
Mailing Address - Country:US
Mailing Address - Phone:919-358-2107
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 34
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:NC
Practice Address - Zip Code:27342-0034
Practice Address - Country:US
Practice Address - Phone:919-358-2107
Practice Address - Fax:919-358-2107
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0126551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical