Provider Demographics
NPI:1780882597
Name:RODGERS, ALLISON (MA, MFT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SEVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST.
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:714-665-2506
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST.
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:714-665-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40649106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist