Provider Demographics
NPI:1649619230
Name:RODDY, RACHEL ELAINE (MA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELAINE
Last Name:RODDY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ORACLE CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4322
Mailing Address - Country:US
Mailing Address - Phone:423-972-1134
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7556
Practice Address - Country:US
Practice Address - Phone:423-232-6281
Practice Address - Fax:423-232-6282
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor