Provider Demographics
NPI:1134969298
Name:FREDERICK, RODNEY (LPCA)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 OLD LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:KY
Mailing Address - Zip Code:40010-9547
Mailing Address - Country:US
Mailing Address - Phone:502-222-2389
Mailing Address - Fax:
Practice Address - Street 1:4414 OLD LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:BUCKNER
Practice Address - State:KY
Practice Address - Zip Code:40010-9547
Practice Address - Country:US
Practice Address - Phone:502-222-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291838101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor