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General NPI Number Information
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NPI Number | 1396362349
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Entity Type | Individual
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Provider Name | HAILEY RODGERS CPRS
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Gender | Female
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 2408 SUSANNAH ST STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1765
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Country | US
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Telephone | 423-434-6677
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Fax | 423-461-0000
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Provider Business Mailing Address
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Address Line | 504 BEECHWOOD DR
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City | KINGSPORT
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State | TN
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Zip | 37663-2455
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Country | US
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Telephone | 423-767-0830
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1234
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1234
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License Number State | TN
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