Provider Demographics
NPI:1699064352
Name:RHODES, JASON (LCSW-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10760 HICKORY RIDGE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3624
Mailing Address - Country:US
Mailing Address - Phone:410-740-7397
Mailing Address - Fax:
Practice Address - Street 1:10760 HICKORY RIDGE RD STE 211
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3624
Practice Address - Country:US
Practice Address - Phone:410-740-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical