Provider Demographics
NPI:1255887055
Name:FENCEROY, RODEISHA
Entity type:Individual
Prefix:
First Name:RODEISHA
Middle Name:
Last Name:FENCEROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 267
Mailing Address - Street 2:
Mailing Address - City:COLLINSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71229
Mailing Address - Country:US
Mailing Address - Phone:318-355-0861
Mailing Address - Fax:318-388-0267
Practice Address - Street 1:4718 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSTON
Practice Address - State:LA
Practice Address - Zip Code:71229
Practice Address - Country:US
Practice Address - Phone:318-355-0861
Practice Address - Fax:318-388-0267
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor