Basic Information
| Provider Information | |||||||||
| NPI: | 1124156542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOUSA | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 756 VALLOMBROSA AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959264041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308915035 | ||||||||
| FaxNumber: | 5306956548 | ||||||||
| Practice Location | |||||||||
| Address1: | 592 RIO LINDO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912999 | ||||||||
| FaxNumber: | 5308956548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21052 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.