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General NPI Number Information
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NPI Number | 1194206151
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Entity Type | Individual
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Provider Name | GLODELIZ RODRIGUEZ LPC, CSAC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 247 MCLAWS CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5660
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Country | US
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Telephone | 757-253-0111
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Fax | 757-253-2884
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Provider Business Mailing Address
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Address Line | 4692 NOLAND BLVD
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-7587
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Country | US
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Telephone | 252-341-8351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102911
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License Number State | VA
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