Provider Demographics
NPI:1164068797
Name:LINES, RHONDA MAE (LCDC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:MAE
Last Name:LINES
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HEMPHILL ST STE A
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3105
Mailing Address - Country:US
Mailing Address - Phone:817-334-0111
Mailing Address - Fax:
Practice Address - Street 1:700 HEMPHILL ST STE A
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3105
Practice Address - Country:US
Practice Address - Phone:817-334-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)