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General NPI Number Information
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NPI Number | 1578162970
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Entity Type | Individual
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Provider Name | STELLA DIMARIS CRUZ RODRIGUEZ PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 1025 VETERANS MEMORIAL HWY SE STE 660
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City | MABLETON
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State | GA
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Zip | 30126-7711
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Country | US
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Telephone | 470-568-3611
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Fax | 762-212-4390
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Provider Business Mailing Address
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Address Line | 1025 VETERANS MEMORIAL HWY SE STE 660
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City | MABLETON
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State | GA
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Zip | 30126-7711
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Country | US
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Telephone | 470-568-3611
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY004432
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License Number State | GA
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