Provider Demographics
NPI:1962687798
Name:SMILLIE, RHONDA SHAW (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SHAW
Last Name:SMILLIE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N LUCIA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3219
Mailing Address - Country:US
Mailing Address - Phone:662-801-4947
Mailing Address - Fax:662-236-3071
Practice Address - Street 1:121 N LUCIA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3219
Practice Address - Country:US
Practice Address - Phone:662-801-4947
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0747101YM0800X
CA4170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1203OtherLPC/ MENTAL HEALTH