Provider Demographics
NPI:1891279287
Name:RODGERS, RICHARD L JR (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 OHIO BLVD SUITE 113-1
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2389
Mailing Address - Country:US
Mailing Address - Phone:812-203-4380
Mailing Address - Fax:812-638-4369
Practice Address - Street 1:2901 OHIO BLVD SUITE 113-1
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2389
Practice Address - Country:US
Practice Address - Phone:812-203-4380
Practice Address - Fax:812-638-4369
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008256A104100000X
IL149.020534104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker