Provider Demographics
NPI:1336299627
Name:RHODES, CAROL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:RHODES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4712
Mailing Address - Country:US
Mailing Address - Phone:248-299-8989
Mailing Address - Fax:
Practice Address - Street 1:3585 WARWICK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4712
Practice Address - Country:US
Practice Address - Phone:248-299-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F3 49039-681Medicare ID - Type Unspecified