Provider Demographics
NPI:1932881141
Name:RODRIGUEZ BECERRA, AZUCENA DE MARIA (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:AZUCENA
Middle Name:DE MARIA
Last Name:RODRIGUEZ BECERRA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:AZUCENA
Other - Middle Name:DE MARIA
Other - Last Name:RODRIGUEZ RENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:710 S THORNTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8421
Mailing Address - Country:US
Mailing Address - Phone:706-459-1853
Mailing Address - Fax:
Practice Address - Street 1:710 S THORNTON AVE STE F
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8421
Practice Address - Country:US
Practice Address - Phone:706-459-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0055541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical