Provider Demographics
NPI:1164032108
Name:HALLOCK, RHONDA LEA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEA
Last Name:HALLOCK
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 1:3081 POMONA LN
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5199
Mailing Address - Country:US
Mailing Address - Phone:707-599-3941
Mailing Address - Fax:
Practice Address - Street 1:2670 JACOBY CREEK RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:CA
Practice Address - Zip Code:95524-9379
Practice Address - Country:US
Practice Address - Phone:707-672-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-36212106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician