Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003456682 |
---|---|
Provider Name | Melissa Rodriguez |
First Address | Durham, NC 27709-3289 |
Second Address | Charlotte, NC 28203-6046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2020 |
Last Update Date | 10/01/2020 |