Provider Demographics
NPI:1932597366
Name:VANDIVER, RHONIKA (MSW)
Entity Type:Individual
Prefix:MS
First Name:RHONIKA
Middle Name:
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LANGFORD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1417
Mailing Address - Country:US
Mailing Address - Phone:760-380-5644
Mailing Address - Fax:760-380-3906
Practice Address - Street 1:111 LANGFORD LAKE RD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1417
Practice Address - Country:US
Practice Address - Phone:760-380-5644
Practice Address - Fax:760-380-3906
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor