Provider Demographics
NPI:1457652786
Name:RODRIGUEZ, LALY JANNETTE
Entity Type:Individual
Prefix:
First Name:LALY
Middle Name:JANNETTE
Last Name:RODRIGUEZ
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 1:421 ALDERSTON WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9531
Mailing Address - Country:US
Mailing Address - Phone:803-445-6310
Mailing Address - Fax:
Practice Address - Street 1:2805 MILLWOOD AVE
Practice Address - Street 2:THRIVEWORKS COUNSELING AND LIFE COACHING
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1298
Practice Address - Country:US
Practice Address - Phone:803-445-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6428101YM0800X
NC10595101YM0800X
NC507780101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)