Provider Demographics
NPI:1457597502
Name:WILSON, RHONDA GOREE (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:GOREE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5755
Mailing Address - Country:US
Mailing Address - Phone:972-272-6554
Mailing Address - Fax:972-272-7929
Practice Address - Street 1:601 CLARA BARTON BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5755
Practice Address - Country:US
Practice Address - Phone:972-272-6554
Practice Address - Fax:972-272-7929
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker