Provider Demographics
NPI:1659960995
Name:PAUL, RODDIA JENNISE (LPA)
Entity Type:Individual
Prefix:MS
First Name:RODDIA
Middle Name:JENNISE
Last Name:PAUL
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 BRANCH AVE APT 616
Mailing Address - Street 2:
Mailing Address - City:HILLCREST HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1018
Mailing Address - Country:US
Mailing Address - Phone:202-910-6109
Mailing Address - Fax:
Practice Address - Street 1:3001 BRANCH AVE APT 616
Practice Address - Street 2:
Practice Address - City:HILLCREST HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20748-1018
Practice Address - Country:US
Practice Address - Phone:202-910-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0666167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician