Provider Demographics
NPI:1043459399
Name:RODGERS, CHAD A
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 W COLTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4554
Mailing Address - Country:US
Mailing Address - Phone:909-792-0747
Mailing Address - Fax:909-792-2045
Practice Address - Street 1:15447 ANACAPA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2481
Practice Address - Country:US
Practice Address - Phone:760-245-9446
Practice Address - Fax:790-751-8986
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor