Provider Demographics
NPI:1811057177
Name:PAYNE, RHONDA (ACSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3914
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-3914
Mailing Address - Country:US
Mailing Address - Phone:901-767-0990
Mailing Address - Fax:901-755-2040
Practice Address - Street 1:780 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9426
Practice Address - Country:US
Practice Address - Phone:901-767-0990
Practice Address - Fax:901-755-2040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3921519Medicare ID - Type Unspecified
R96304Medicare UPIN