Provider Demographics
NPI:1184303778
Name:WADDELL, RHONDDA FAYE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:RHONDDA
Middle Name:FAYE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 REDWATER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-6141
Mailing Address - Country:US
Mailing Address - Phone:352-226-6057
Mailing Address - Fax:
Practice Address - Street 1:250 REDWATER LAKE RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-6141
Practice Address - Country:US
Practice Address - Phone:352-226-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical