Provider Demographics
NPI:1407092554
Name:RONDEL ASENCIO, CASSANDRA RHEA (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RHEA
Last Name:RONDEL ASENCIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:RHEA
Other - Last Name:RONDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 HILLANDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0994
Mailing Address - Country:US
Mailing Address - Phone:734-972-8970
Mailing Address - Fax:704-672-0726
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY STE 222
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3416
Practice Address - Country:US
Practice Address - Phone:704-672-0578
Practice Address - Fax:704-672-0726
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0138781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7606Medicaid