Provider Demographics
NPI:1366745747
Name:RODGERS, THEODORE
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:RODGERS
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 1:835 CASTRO ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1611
Mailing Address - Country:US
Mailing Address - Phone:925-265-6660
Mailing Address - Fax:925-646-1155
Practice Address - Street 1:835 CASTRO ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1611
Practice Address - Country:US
Practice Address - Phone:925-265-6660
Practice Address - Fax:925-646-1155
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor