Provider Demographics
NPI:1558583286
Name:RODGERS, CAROL A (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8428
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-8428
Mailing Address - Country:US
Mailing Address - Phone:530-662-6653
Mailing Address - Fax:530-662-1770
Practice Address - Street 1:285 W COURT ST STE 202
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2977
Practice Address - Country:US
Practice Address - Phone:530-661-9969
Practice Address - Fax:530-662-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT21800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC21800OtherMFC LICENSE