Provider Demographics
NPI:1932973179
Name:WILSON, RHONDA DANIELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:DANIELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 SUGARBUSH DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9489
Mailing Address - Country:US
Mailing Address - Phone:312-282-0977
Mailing Address - Fax:
Practice Address - Street 1:30772 SOUTHVIEW DR STE 120
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2214
Practice Address - Country:US
Practice Address - Phone:303-670-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health