Provider Demographics
NPI:1184385635
Name:RODRIGUEZ, ALICE (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SUNCAST LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9335
Mailing Address - Country:US
Mailing Address - Phone:916-542-8893
Mailing Address - Fax:
Practice Address - Street 1:1020 SUNCAST LN
Practice Address - Street 2:SUITE 104
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9335
Practice Address - Country:US
Practice Address - Phone:916-542-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPPC10720101YA0400X, 101YP2500X, 102L00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst