Provider Demographics
NPI:1003115874
Name:ROGERS, DAVID JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PUMP RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-3539
Mailing Address - Country:US
Mailing Address - Phone:804-922-1486
Mailing Address - Fax:
Practice Address - Street 1:10426 SUMMER HILL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-6613
Practice Address - Country:US
Practice Address - Phone:804-922-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional