Provider Demographics
NPI:1750785614
Name:RODRIGUEZ, WILLIAM HERNANDO
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HERNANDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:HERNANDO
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1029 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3686
Mailing Address - Country:US
Mailing Address - Phone:919-943-5254
Mailing Address - Fax:
Practice Address - Street 1:1029 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3686
Practice Address - Country:US
Practice Address - Phone:919-943-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral