Provider Demographics
NPI:1629251723
Name:RODRIGUEZ, TRACEY LYNETTE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WIND CHIME CT STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6573
Mailing Address - Country:US
Mailing Address - Phone:253-576-3898
Mailing Address - Fax:253-655-2055
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-576-3898
Practice Address - Fax:253-655-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00048627101YM0800X
NC12920S101YM0800X
WALH60161094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health