Provider Demographics
NPI:1134632771
Name:BLACKBURN, RHONDA HARDIN (MA)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:HARDIN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5922
Mailing Address - Country:US
Mailing Address - Phone:256-366-4254
Mailing Address - Fax:
Practice Address - Street 1:1 CENTERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3713
Practice Address - Country:US
Practice Address - Phone:336-617-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13455101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty