MEDICARE: RHONDA MAE LINES LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	14465	TX

General Provider Information

NPI Number	:	1164068797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA MAE LINES LCDC

Provider Business Mailing Address
First Line	:	700 HEMPHILL ST STE A
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3105
Country	:	US
Telephone Number	:	817-334-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 HEMPHILL ST STE A
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3105
Country	:	US
Telephone Number	:	817-334-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “ RHONDA MAE LINES LCDC” Practice Location

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