Individual
MS. RONDA LYNN HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC LICENSED PROFESS
Contact information
Practice address
2495 N MLK DR, ORANGE, TX 77630
(409) 882-9038
Mailing address
2800 34TH ST, ORANGE, TX 77630-1908
(409) 882-9038
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LPC13841
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176409
COMPSYCH
—
01
—
7521LC
BLUE SHIELD
TX
01
—
MHS154742
VALUE OPTIONS
—
Enumeration date
03/21/2007
Last updated
07/08/2007
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