Basic Information
| Provider Information | |||||||||
| NPI: | 1689895021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | SHERYLL | ||||||||
| MiddleName: | LYNETT | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21420 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480765546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483571218 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1424 E 11 MILE RD | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480672026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485484044 | ||||||||
| FaxNumber: | 2885489239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401001476 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.