Provider Demographics
NPI:1790837144
Name:RODINE, MARCIA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:RODINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:NIELSEN
Other - Last Name:RODINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:745 ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2905
Mailing Address - Country:US
Mailing Address - Phone:541-821-6578
Mailing Address - Fax:
Practice Address - Street 1:745 ALASKA ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2905
Practice Address - Country:US
Practice Address - Phone:541-821-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8076900000OtherBLUE SHIELD/ BLUE CROSS