Provider Demographics
NPI:1023389459
Name:ROGER, DAWN B (CAC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:B
Last Name:ROGER
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3008
Mailing Address - Country:US
Mailing Address - Phone:337-262-4155
Mailing Address - Fax:337-262-1146
Practice Address - Street 1:302 DULLES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3008
Practice Address - Country:US
Practice Address - Phone:337-262-4155
Practice Address - Fax:337-262-1146
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACAC 1261101YA0400X
LALAC1261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)