Provider Demographics
NPI:1184760738
Name:RODRIGUEZ, DIANA BENJAMIN (LCSW CADC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BENJAMIN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BENJAMIN RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCW CADC
Mailing Address - Street 1:6340 SUGARLOAF PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-775-6750
Mailing Address - Fax:678-623-3396
Practice Address - Street 1:6340 SUGARLOAF PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:678-775-6750
Practice Address - Fax:678-623-3396
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC0019101YA0400X
GAICAADC1308101YA0400X
GA24001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFXNMedicare ID - Type Unspecified