Provider Demographics
NPI:1326547449
Name:DAVIS, RHONDA LYNN (MDIV, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MDIV, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 IDLEWILDE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3929
Mailing Address - Country:US
Mailing Address - Phone:336-406-0017
Mailing Address - Fax:
Practice Address - Street 1:127 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3755
Practice Address - Country:US
Practice Address - Phone:336-406-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0085661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical