Provider Demographics
NPI:1174020655
Name:IVORY, RONDA J (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:J
Last Name:IVORY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 HILBORN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7993
Mailing Address - Country:US
Mailing Address - Phone:707-646-9838
Mailing Address - Fax:
Practice Address - Street 1:3694 HILBORN RD STE 150
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7993
Practice Address - Country:US
Practice Address - Phone:707-646-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist