Provider Demographics
NPI:1194206151
Name:RODRIGUEZ, GLODELIZ (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:GLODELIZ
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4692 NOLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7587
Mailing Address - Country:US
Mailing Address - Phone:252-341-8351
Mailing Address - Fax:
Practice Address - Street 1:247 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5660
Practice Address - Country:US
Practice Address - Phone:757-253-0111
Practice Address - Fax:757-253-2884
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102911101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)