Healthcare Provider Details

I. General information

NPI: 1932066511
Provider Name (Legal Business Name): DARRYL LEE RODGERS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 FAIRWAY DR NE
WARREN OH
44483-5637
US

IV. Provider business mailing address

881 FAIRWAY DR NE
WARREN OH
44483-5637
US

V. Phone/Fax

Practice location:
  • Phone: 330-984-2012
  • Fax:
Mailing address:
  • Phone: 330-984-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number943868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: