Provider Demographics
NPI:1528350295
Name:RODRIGUEZ, SHELLY HOULE (LCMHC, LADC)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:HOULE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:MARIE
Other - Last Name:HOULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:272 NORTH MAINE STREET
Mailing Address - Street 2:ROOM # 223
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444
Mailing Address - Country:US
Mailing Address - Phone:802-644-1460
Mailing Address - Fax:
Practice Address - Street 1:1205 UPPER PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05444
Practice Address - Country:US
Practice Address - Phone:802-324-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000482101YA0400X
VT0680057754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)