Provider Demographics
NPI:1780419143
Name:RODGERS, ADRIENNE ROBERTA
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:ROBERTA
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 JACKIES WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4819
Mailing Address - Country:US
Mailing Address - Phone:301-639-3378
Mailing Address - Fax:
Practice Address - Street 1:INTERDYNAMICS, INC.
Practice Address - Street 2:8181 PROFESSIONAL PLACE, SUITE 200
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:301-306-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health