Provider Demographics
NPI:1699034306
Name:KOZUMPLIK, RHONDA LEE (MA LPC, CADC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:KOZUMPLIK
Suffix:
Gender:F
Credentials:MA LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9130 MCWAIN RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8005
Mailing Address - Country:US
Mailing Address - Phone:810-625-3002
Mailing Address - Fax:
Practice Address - Street 1:8245 HOLLY RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2483
Practice Address - Country:US
Practice Address - Phone:810-625-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222842101Y00000X
MI6401013075101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional