Provider Demographics
NPI:1447548110
Name:RHOADES, COLIN JOHN (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JOHN
Last Name:RHOADES
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 BALTIMORE NATIONAL PIKE # 192
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3369
Mailing Address - Country:US
Mailing Address - Phone:443-694-6119
Mailing Address - Fax:
Practice Address - Street 1:8480 BALTIMORE NATIONAL PIKE # 192
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3369
Practice Address - Country:US
Practice Address - Phone:443-694-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2386101YP1600X, 101YP2500X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor