Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PS005058L | PA |
N | 102L00000X | Psychologist | PS005058L | PA |
N | 103T00000X | Psychologist | PS005058L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TC1900X | Counseling Psychologist | PS005058L | PA |
N | 103TP2701X | Group Psychotherapist | ||
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 103TR0400X | Rehabilitation Psychologist | PA005058L | PA |
NPI | 1467839639 |
---|---|
Provider Name | Don Rhoades |
First Address | New Hope, PA 18938-1337 |
Second Address | New Hope, PA 18938-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 30/04/2015 |