Provider Demographics
NPI:1003449109
Name:RODRIGUEZ, RAQUEL R (LPC)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:R
Last Name:RODRIGUEZ
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 1:11400 N VAL VERDE RD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-5479
Mailing Address - Country:US
Mailing Address - Phone:956-929-8945
Mailing Address - Fax:
Practice Address - Street 1:11400 N VAL VERDE RD
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-5479
Practice Address - Country:US
Practice Address - Phone:956-929-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional