Provider Demographics
NPI:1417421017
Name:RODRIGUE, CHRISTINE BROUSSARD (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BROUSSARD
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:BROUSSARD
Other - Last Name:DUSANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4728 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-236-6007
Mailing Address - Fax:504-734-3707
Practice Address - Street 1:4728 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-236-6007
Practice Address - Fax:504-734-3707
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7956101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health