Provider Demographics
NPI:1326221219
Name:KOONCE, RHONDA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:KOONCE
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 1:5325 GREENWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-881-2822
Mailing Address - Fax:
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-881-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811955400Medicaid
FL914570200Medicaid