Provider Demographics
NPI:1386656486
Name:SPROLES, RHONDA T (LCSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:T
Last Name:SPROLES
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5900
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:6515 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:STE 100
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-2182
Practice Address - Country:US
Practice Address - Phone:757-877-9140
Practice Address - Fax:757-877-3925
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA257114OtherANTHEM
VA8926263Medicaid
403506OtherVALUE OPTIONS
VA8926263Medicaid
VA800002703Medicare ID - Type Unspecified