Provider Demographics
NPI:1073635074
Name:RODGERS, ANGELA A (LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 FLAGSTAFF COVE
Mailing Address - Street 2:HARVEST COUNSELING GROUP INC
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4417
Mailing Address - Country:US
Mailing Address - Phone:260-485-4357
Mailing Address - Fax:260-485-4357
Practice Address - Street 1:4216 FLAGSTAFF COVE
Practice Address - Street 2:HARVEST COUNSELING GROUP INC
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4417
Practice Address - Country:US
Practice Address - Phone:260-485-4357
Practice Address - Fax:260-485-4357
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001695A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000493226OtherANTHEM