Provider Demographics
NPI:1134611239
Name:RODGERS, ALYSSA LATONIA (NCC, LCAS-A, IL: LPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LATONIA
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NCC, LCAS-A, IL: LPC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LATONIA
Other - Last Name:IDLEBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7512 SPRING SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1417
Mailing Address - Country:US
Mailing Address - Phone:309-573-5818
Mailing Address - Fax:
Practice Address - Street 1:7512 SPRING SPRUCE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:309-573-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24523101YA0400X
IL178.012997101YM0800X
NCA13964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)