Provider Demographics
NPI:1831356864
Name:RODRIGUEZ, JARISKA K (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:JARISKA
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 CANE MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-7114
Mailing Address - Country:US
Mailing Address - Phone:229-789-4400
Mailing Address - Fax:
Practice Address - Street 1:514 W OGLETHORPE BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2838
Practice Address - Country:US
Practice Address - Phone:205-304-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0200X
GALPC008506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003172200AMedicaid