Provider Demographics
NPI:1255431391
Name:RODRIGUEZ, CHRISTOPHER PAUL (MA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:P
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2990 BETHESDA PL
Mailing Address - Street 2:SUITE 604A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3318
Mailing Address - Country:US
Mailing Address - Phone:336-413-3181
Mailing Address - Fax:
Practice Address - Street 1:2990 BETHESDA PL
Practice Address - Street 2:SUITE 604A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3318
Practice Address - Country:US
Practice Address - Phone:336-413-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist