Provider Demographics
NPI:1992548945
Name:REYES RODRIGUEZ, DAKOTA ROSE MARIE
Entity type:Individual
Prefix:MRS
First Name:DAKOTA ROSE
Middle Name:MARIE
Last Name:REYES RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 LONNIE CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9504
Mailing Address - Country:US
Mailing Address - Phone:631-278-8805
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST STE 610
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3048
Practice Address - Country:US
Practice Address - Phone:615-560-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician