Healthcare Provider Details

I. General information

NPI: 1194149518
Provider Name (Legal Business Name): CHRISTINA RODRIGUEZ LSW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 TRANSVERSE DR
TOLEDO OH
43614-8008
US

IV. Provider business mailing address

4510 DORR ST # MS 840
TOLEDO OH
43615-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-6843
  • Fax: 419-383-3338
Mailing address:
  • Phone: 419-383-6843
  • Fax: 419-383-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICDC.111076
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1100272
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: