Provider Demographics
NPI:1649306887
Name:RODRIGUEZ, GERALDINE MARIA (LPC)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GERRIE
Other - Middle Name:M
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13536 LEITH CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3317
Mailing Address - Country:US
Mailing Address - Phone:703-631-8316
Mailing Address - Fax:
Practice Address - Street 1:4124 WALNEY RD
Practice Address - Street 2:STE. N
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2937
Practice Address - Country:US
Practice Address - Phone:703-631-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional