Provider Demographics
NPI:1326104167
Name:HIDAJI, RHONDA GAIL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:GAIL
Last Name:HIDAJI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 EXETER ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-757-7706
Mailing Address - Fax:901-755-6152
Practice Address - Street 1:2022 EXETER ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-757-7706
Practice Address - Fax:901-755-6152
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000041031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN403559OtherBLUE CROSS BLUE SHIELD