Healthcare Provider Details

I. General information

NPI: 1023561636
Provider Name (Legal Business Name): RHONDA MATHIS ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2016
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E FRONT ST
PLAINFIELD NJ
07060-1414
US

IV. Provider business mailing address

675 W 7TH ST APT 3
PLAINFIELD NJ
07060-2063
US

V. Phone/Fax

Practice location:
  • Phone: 908-636-4049
  • Fax:
Mailing address:
  • Phone: 908-636-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number14-104
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00698900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: