Provider Demographics
NPI:1740204155
Name:HURST, RHODA ELENA (PH D, LCSW)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:ELENA
Last Name:HURST
Suffix:
Gender:F
Credentials:PH D, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 INDIAN VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6809
Mailing Address - Country:US
Mailing Address - Phone:540-763-4053
Mailing Address - Fax:540-763-4053
Practice Address - Street 1:571 INDIAN VALLEY RD NW
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-6809
Practice Address - Country:US
Practice Address - Phone:540-763-4053
Practice Address - Fax:540-763-4053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186881OtherBLUE CROSS BLUE SHIELD
VA010225591Medicaid
VAP00317822Medicare PIN
VA008877T06Medicare PIN