Provider Demographics
NPI:1316398290
Name:CLARK-MOSES, RHONDA R (MS, LLPC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:CLARK-MOSES
Suffix:
Gender:F
Credentials:MS, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 S WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4958
Mailing Address - Country:US
Mailing Address - Phone:989-755-1072
Mailing Address - Fax:989-755-1401
Practice Address - Street 1:3400 S WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4958
Practice Address - Country:US
Practice Address - Phone:989-755-1072
Practice Address - Fax:989-755-1401
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015756101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401015756OtherLLPC