MEDICARE: MRS. ROSE ELIZABETH RODRIGUEZ M.S. COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861723876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE ELIZABETH RODRIGUEZ M.S. COUNSELING

Provider Business Mailing Address
First Line	:	6413 EHLER COURT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409
Country	:	US
Telephone Number	:	910-397-7634
Fax Number	:

Provider Business Practice Location Address
First Line	:	6413 EHLER CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4553
Country	:	US
Telephone Number	:	910-397-7634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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