Provider Demographics
NPI:1912047622
Name:GARDNER, RHONDA JOSEPHINE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:JOSEPHINE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35948 VAUGHN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4432
Mailing Address - Country:US
Mailing Address - Phone:313-598-0928
Mailing Address - Fax:
Practice Address - Street 1:6555 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4511
Practice Address - Country:US
Practice Address - Phone:586-783-8113
Practice Address - Fax:586-469-7925
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009119101YP2500X
MI6401018259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional