Provider Demographics
NPI:1295098879
Name:ESCOBAR, RODOLFO M JR (LPC)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:M
Last Name:ESCOBAR
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 KIRBY CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4217
Mailing Address - Country:US
Mailing Address - Phone:757-587-3444
Mailing Address - Fax:
Practice Address - Street 1:225 W OLNEY RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1534
Practice Address - Country:US
Practice Address - Phone:757-823-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional