Provider Demographics
NPI:1407070311
Name:RODRIGUES, MICHELLE FRANCINE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FRANCINE
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 N PERSHING AVE
Mailing Address - Street 2:NUMBER 9
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6949
Mailing Address - Country:US
Mailing Address - Phone:209-644-6328
Mailing Address - Fax:
Practice Address - Street 1:8026 LORRAINE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4224
Practice Address - Country:US
Practice Address - Phone:209-644-6328
Practice Address - Fax:209-644-6308
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)