Healthcare Provider Details

I. General information

NPI: 1831356864
Provider Name (Legal Business Name): JARISKA K RODRIGUEZ PSY.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W OGLETHORPE BLVD
ALBANY GA
31701-2838
US

IV. Provider business mailing address

3143 CANE MILL DR
ALBANY GA
31721-7114
US

V. Phone/Fax

Practice location:
  • Phone: 205-304-1506
  • Fax:
Mailing address:
  • Phone: 229-789-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008506
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: