Provider Demographics
NPI:1124716808
Name:RHODES, MICHELLE A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:RHODES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:4460 N ILLINOIS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1899
Mailing Address - Country:US
Mailing Address - Phone:949-307-6142
Mailing Address - Fax:
Practice Address - Street 1:4460 N ILLINOIS ST STE 1
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1899
Practice Address - Country:US
Practice Address - Phone:949-307-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022012323101Y00000X
1041C0700X
IL149025207101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical