Provider Demographics
NPI:1518426105
Name:WINGER RODRIGUEZ, STEPHANIE C (LGPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:WINGER RODRIGUEZ
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:WINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14228 CHADWICK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2106
Mailing Address - Country:US
Mailing Address - Phone:571-970-8246
Mailing Address - Fax:
Practice Address - Street 1:8730 GEORGIA AVE STE 200B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3604
Practice Address - Country:US
Practice Address - Phone:301-960-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty