Provider Demographics
NPI:1760144752
Name:FOXWORTHY, RHONDA SCOTT
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SCOTT
Last Name:FOXWORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 PIEDMONT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-3632
Mailing Address - Country:US
Mailing Address - Phone:678-898-2365
Mailing Address - Fax:
Practice Address - Street 1:1329 PIEDMONT LAKE RD
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:31822-3632
Practice Address - Country:US
Practice Address - Phone:678-898-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty