Provider Demographics
NPI:1760072797
Name:RODRIGUEZ, SABRINA SUZANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:SUZANNE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 GALWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6764
Mailing Address - Country:US
Mailing Address - Phone:847-962-7357
Mailing Address - Fax:
Practice Address - Street 1:4261 GALWAY DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6764
Practice Address - Country:US
Practice Address - Phone:847-962-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional