Provider Demographics
NPI:1366691180
Name:RODGERS, BRANDI D (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:D
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4510
Mailing Address - Country:US
Mailing Address - Phone:501-575-0452
Mailing Address - Fax:877-991-8005
Practice Address - Street 1:21 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4510
Practice Address - Country:US
Practice Address - Phone:501-575-0452
Practice Address - Fax:877-991-8005
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5461-C1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1548704521OtherORGANIZATION NPI