Provider Demographics
NPI:1003289216
Name:ROGERS, CHARITY (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC, LCDC
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 69
Mailing Address - Street 2:
Mailing Address - City:PAIGE
Mailing Address - State:TX
Mailing Address - Zip Code:78659-0069
Mailing Address - Country:US
Mailing Address - Phone:512-217-9034
Mailing Address - Fax:
Practice Address - Street 1:153 RIDGEWAY CEMETERY ROAD
Practice Address - Street 2:
Practice Address - City:PAIGE
Practice Address - State:TX
Practice Address - Zip Code:78659
Practice Address - Country:US
Practice Address - Phone:512-660-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10433101YA0400X
TX74820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)