Provider Demographics
NPI:1578098968
Name:RODRIGUEZ, JENNIFER (MA, LPC-I)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MAGNOLIA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 MAGNOLIA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7019
Practice Address - Country:US
Practice Address - Phone:843-619-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional