Provider Demographics
NPI:1417249616
Name:RODRIGUEZ, NAKISHA DESHAWN (LCMHCS)
Entity Type:Individual
Prefix:MRS
First Name:NAKISHA
Middle Name:DESHAWN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NEUSE BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6119
Mailing Address - Country:US
Mailing Address - Phone:252-259-3114
Mailing Address - Fax:
Practice Address - Street 1:126 NEUSE BLUFF CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6119
Practice Address - Country:US
Practice Address - Phone:252-259-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10927841-6004101YM0800X
NCS8719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health