Provider Demographics
NPI:1225182199
Name:CROSS, RHONDA S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:S
Last Name:CROSS
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 1:502 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3400
Mailing Address - Country:US
Mailing Address - Phone:423-562-4190
Mailing Address - Fax:423-566-3718
Practice Address - Street 1:502 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3400
Practice Address - Country:US
Practice Address - Phone:423-562-4190
Practice Address - Fax:423-566-3718
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000003058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN481897Medicaid
TN481897Medicaid
OTH000Medicare UPIN