Provider Demographics
NPI:1447403142
Name:RODGERS, LAVONNE MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAVONNE
Middle Name:MARIE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KANDI
Other - Middle Name:MARIE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:385 GARRISONVILLE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8900
Mailing Address - Country:US
Mailing Address - Phone:540-657-1228
Mailing Address - Fax:540-657-1999
Practice Address - Street 1:385 GARRISONVILLE RD STE 113
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8900
Practice Address - Country:US
Practice Address - Phone:540-657-1228
Practice Address - Fax:540-657-1999
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health