Provider Demographics
NPI:1699045781
Name:BOHANON, RHONDA (PLMSW)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:BOHANON
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 N CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2002
Mailing Address - Country:US
Mailing Address - Phone:870-295-3300
Mailing Address - Fax:
Practice Address - Street 1:703 CALVIN AVERY DR
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-6501
Practice Address - Country:US
Practice Address - Phone:870-732-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186801795Medicaid