Provider Demographics
NPI:1629818786
Name:RODGERS, ANGELA MARIE (RADT)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2727
Mailing Address - Country:US
Mailing Address - Phone:559-635-8010
Mailing Address - Fax:559-635-1411
Practice Address - Street 1:401 W TULARE ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2634
Practice Address - Country:US
Practice Address - Phone:559-635-8010
Practice Address - Fax:559-635-1411
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1561530524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)