Provider Demographics
NPI:1023139755
Name:BAQUERIZO, ROCIO (LPC,CS,NCC)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:BAQUERIZO
Suffix:
Gender:F
Credentials:LPC,CS,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670685
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0685
Mailing Address - Country:US
Mailing Address - Phone:907-444-4908
Mailing Address - Fax:
Practice Address - Street 1:48000 ARMORY GUARD RD
Practice Address - Street 2:D103
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-382-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2367101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)