Provider Demographics
NPI:1689150336
Name:AVERHART, RHONDA F (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:F
Last Name:AVERHART
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E FLORIDA AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-6007
Mailing Address - Country:US
Mailing Address - Phone:708-752-0650
Mailing Address - Fax:
Practice Address - Street 1:5501 S CORNELL AVE # 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-5819
Practice Address - Country:US
Practice Address - Phone:708-752-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty