Provider Demographics
NPI:1912475518
Name:RODRIGUEZ, CHRISTINA ASHA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ASHA
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:CHERRY LOG
Mailing Address - State:GA
Mailing Address - Zip Code:30522-0342
Mailing Address - Country:US
Mailing Address - Phone:706-980-3416
Mailing Address - Fax:
Practice Address - Street 1:7540 HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:BRASSTOWN
Practice Address - State:NC
Practice Address - Zip Code:28902-8079
Practice Address - Country:US
Practice Address - Phone:828-837-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24321Medicaid