Provider Demographics
NPI:1669759254
Name:RODRIGUEZ VREM, TATIANA H (LCPC, LCADC, NCC,ACS)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:H
Last Name:RODRIGUEZ VREM
Suffix:
Gender:F
Credentials:LCPC, LCADC, NCC,ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10665 STANHAVEN PLACE
Mailing Address - Street 2:SUITE 3109
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695
Mailing Address - Country:US
Mailing Address - Phone:301-538-3899
Mailing Address - Fax:
Practice Address - Street 1:10665 STANHAVEN PL
Practice Address - Street 2:SUITE 3109
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3055
Practice Address - Country:US
Practice Address - Phone:301-538-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1813101YA0400X
MDLC1917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)