Provider Demographics
NPI:1699039396
Name:RODGERS, EDEN MARIE BROCK (EDS/MS)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:MARIE BROCK
Last Name:RODGERS
Suffix:
Gender:F
Credentials:EDS/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 HUTTERSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-1203
Mailing Address - Country:US
Mailing Address - Phone:850-528-1995
Mailing Address - Fax:
Practice Address - Street 1:3192 HUTTERSFIELD CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-1203
Practice Address - Country:US
Practice Address - Phone:850-528-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health