Provider Demographics
NPI:1700614492
Name:DRAKE, ROD L
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:L
Last Name:DRAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HEMLOCK GREEN LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-8321
Mailing Address - Country:US
Mailing Address - Phone:919-673-0449
Mailing Address - Fax:
Practice Address - Street 1:107 HEMLOCK GREEN LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-8321
Practice Address - Country:US
Practice Address - Phone:919-673-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician