Provider Demographics
NPI:1609521384
Name:JOHNSON, RHONDA JEWELLE (MA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JEWELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WESTGATE CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2984
Mailing Address - Country:US
Mailing Address - Phone:336-341-5354
Mailing Address - Fax:336-450-1504
Practice Address - Street 1:1348 WESTGATE CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2984
Practice Address - Country:US
Practice Address - Phone:336-341-5354
Practice Address - Fax:336-450-1504
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18662443125Medicaid