Provider Demographics
NPI:1215142302
Name:ROPER, RHONDA V (LCSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:V
Last Name:ROPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 EXECUTIVE PARK NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2723
Mailing Address - Country:US
Mailing Address - Phone:423-479-9652
Mailing Address - Fax:
Practice Address - Street 1:2775 EXECUTIVE PARK NW
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2723
Practice Address - Country:US
Practice Address - Phone:423-479-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW30891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4035075OtherBLUE CROSS BLUE SHIELD
TN3699768Medicare ID - Type UnspecifiedMEDICARE