Provider Demographics
NPI:1255493177
Name:RODGERS, LEON JR (EDD, MSW, MHDL, LCSW)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:EDD, MSW, MHDL, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACON RD
Mailing Address - Street 2:SUITE 3080A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2204
Mailing Address - Country:US
Mailing Address - Phone:706-748-2195
Mailing Address - Fax:
Practice Address - Street 1:2960 MACON RD
Practice Address - Street 2:SUITE 3080A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2204
Practice Address - Country:US
Practice Address - Phone:706-748-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical