Provider Demographics
NPI:1114939576
Name:RHOADES, ROGER ALAN (DMIN, LPC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALAN
Last Name:RHOADES
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-2333
Mailing Address - Country:US
Mailing Address - Phone:864-583-5802
Mailing Address - Fax:864-582-2697
Practice Address - Street 1:186 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-2333
Practice Address - Country:US
Practice Address - Phone:864-583-5802
Practice Address - Fax:864-582-2697
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2244101YP2500X
MS0226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional