Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LPC13841 | TX |
Y | 103T00000X | Psychologist | LPC13841 | TX |
NPI | 1013033364 |
---|---|
Provider Name | Ms. Ronda Lynn Hathaway |
First Address | Orange, TX 77630-1908 |
Second Address | Orange, TX 77630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176409 | COMPSYCH (01) | |
7521LC | BLUE SHIELD (01) | TX |
MHS154742 | VALUE OPTIONS (01) |