Provider Demographics
NPI:1184180937
Name:ROGERS, MAE CATHERINE
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:CATHERINE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30410 SOUTHFIELD RD APT 92A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1332
Mailing Address - Country:US
Mailing Address - Phone:313-676-1412
Mailing Address - Fax:
Practice Address - Street 1:300 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2703
Practice Address - Country:US
Practice Address - Phone:313-867-8015
Practice Address - Fax:313-867-8049
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health