Healthcare Provider Details

I. General information

NPI: 1831755230
Provider Name (Legal Business Name): ERIC RODGERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 PARKLAKE DR NE STE 558
ATLANTA GA
30345-2844
US

IV. Provider business mailing address

3904 N DRUID HILLS RD # 232
DECATUR GA
30033-3105
US

V. Phone/Fax

Practice location:
  • Phone: 770-988-6525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC013033
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC013033
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013033
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: