Provider Demographics
NPI:1104981802
Name:RHODES, CHARLES R (LMHC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:RHODES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-9618
Mailing Address - Country:US
Mailing Address - Phone:813-784-9793
Mailing Address - Fax:813-948-0788
Practice Address - Street 1:24160 STATE ROAD 54
Practice Address - Street 2:UNIT 5
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6755
Practice Address - Country:US
Practice Address - Phone:813-784-9793
Practice Address - Fax:813-948-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health