Provider Demographics
NPI:1548316383
Name:RODRIGUEZ, CYNTHIA J
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:RODRIGUEZ
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 1:2409 W. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2409
Mailing Address - Country:US
Mailing Address - Phone:910-735-2273
Mailing Address - Fax:910-735-4263
Practice Address - Street 1:2409 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6261
Practice Address - Country:US
Practice Address - Phone:910-735-2273
Practice Address - Fax:910-735-4263
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCHC3400374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601523Medicaid
NC8301786GMedicaid
NC8301786Medicaid
NC8301786BMedicaid