Provider Demographics
NPI:1124651104
Name:DAVIES, RHONDA ROCHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:ROCHELLE
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:ROCHELLE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:309 COTTESBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5936
Mailing Address - Country:US
Mailing Address - Phone:269-369-5453
Mailing Address - Fax:
Practice Address - Street 1:1250 SE MAYNARD RD STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6947
Practice Address - Country:US
Practice Address - Phone:919-948-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC012219104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker