Provider Demographics
NPI:1023122405
Name:CLAY-DOUTHIT, RASHONDA L (LCSW)
Entity type:Individual
Prefix:
First Name:RASHONDA
Middle Name:L
Last Name:CLAY-DOUTHIT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CHARIOT CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6284
Mailing Address - Country:US
Mailing Address - Phone:678-289-8312
Mailing Address - Fax:
Practice Address - Street 1:611 CHARIOT CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6284
Practice Address - Country:US
Practice Address - Phone:678-270-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA653929715AMedicaid
GA80BBGFLMedicare ID - Type Unspecified
GA653929715AMedicaid