Healthcare Provider Details

I. General information

NPI: 1205488715
Provider Name (Legal Business Name): SARA MICHELLE RODRIGUEZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WESTRIDGE RD
CARLSBAD NM
88220-3550
US

IV. Provider business mailing address

1900 WESTRIDGE RD
CARLSBAD NM
88220-3550
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax: 575-725-5552
Mailing address:
  • Phone: 575-725-5552
  • Fax: 575-725-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0222801
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0222801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: