Provider Demographics
NPI:1205073582
Name:TODD, ROCK ALLEN (LAC, LASAC)
Entity type:Individual
Prefix:
First Name:ROCK
Middle Name:ALLEN
Last Name:TODD
Suffix:
Gender:M
Credentials:LAC, LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE# 160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3001
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:480-962-7671
Practice Address - Street 1:8825 N 23RD AVE
Practice Address - Street 2:SUITE#100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4147
Practice Address - Country:US
Practice Address - Phone:602-861-2255
Practice Address - Fax:602-861-2288
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-13099101YA0400X
AZLAC-12887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health