Provider Demographics
NPI:1215008081
Name:ROGERS, PAUL PROCTOR
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:PROCTOR
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:P.
Other - Middle Name:PROCTOR
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:155 WEST CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2418
Mailing Address - Country:US
Mailing Address - Phone:803-463-6634
Mailing Address - Fax:
Practice Address - Street 1:2638 TWO NOTCH RD
Practice Address - Street 2:106
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1432
Practice Address - Country:US
Practice Address - Phone:803-779-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health