Individual
CHRISTINE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHCA
Contact information
Practice address
6331 CONSTITUTION DR, FORT WAYNE, IN 46804-1547
(260) 823-3100
Mailing address
6038 TANGLE CREEK CT, FORT WAYNE, IN 46814-8228
(260) 416-8577
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88000791A
STATE LICENSE
IN
Enumeration date
06/26/2021
Last updated
06/26/2021
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