Provider Demographics
NPI:1689895021
Name:RODGERS, SHERYLL LYNETT (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHERYLL
Middle Name:LYNETT
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21420 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5546
Mailing Address - Country:US
Mailing Address - Phone:248-357-1218
Mailing Address - Fax:
Practice Address - Street 1:1424 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2026
Practice Address - Country:US
Practice Address - Phone:248-548-4044
Practice Address - Fax:288-548-9239
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health