Provider Demographics
NPI:1831395532
Name:RHODES, CONNIE RENEE (BS, CADC II)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:RENEE
Last Name:RHODES
Suffix:
Gender:F
Credentials:BS, CADC II
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:RENEE
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4330 AUBURN BLVD STE 2200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-4107
Mailing Address - Country:US
Mailing Address - Phone:916-473-5764
Mailing Address - Fax:916-473-5766
Practice Address - Street 1:1789 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5130
Practice Address - Country:US
Practice Address - Phone:209-825-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA820171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)