Provider Demographics
NPI:1427537562
Name:RODECKER, CAROLYN SUE (LPCC-SUPV, LCDCIII)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:RODECKER
Suffix:
Gender:F
Credentials:LPCC-SUPV, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 TREE MOSS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2557
Mailing Address - Country:US
Mailing Address - Phone:216-978-5183
Mailing Address - Fax:
Practice Address - Street 1:6941 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1525
Practice Address - Country:US
Practice Address - Phone:440-427-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1100489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1356718142OtherSTATE OF OHIO