Provider Demographics
NPI:1336735976
Name:EDMONDS, RONDA TERESE (LCSW)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:TERESE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:TERESE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1619 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-4522
Mailing Address - Country:US
Mailing Address - Phone:804-926-9119
Mailing Address - Fax:
Practice Address - Street 1:4901 E PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:BURKEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23922-3454
Practice Address - Country:US
Practice Address - Phone:804-926-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040125431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical