Provider Demographics
NPI:1275362352
Name:RODGERS, AUDREY DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:DENISE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 ROCKBRIDGE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3068
Mailing Address - Country:US
Mailing Address - Phone:678-852-8797
Mailing Address - Fax:
Practice Address - Street 1:1227 ROCKBRIDGE RD STE 208
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3068
Practice Address - Country:US
Practice Address - Phone:678-852-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0080941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty