Provider Demographics
NPI:1275108144
Name:ROGERS, PERI NABIH (LPC)
Entity Type:Individual
Prefix:
First Name:PERI
Middle Name:NABIH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PERIHAN
Other - Middle Name:NABIH
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUPERVISOR
Mailing Address - Street 1:12735 LADY SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2236
Mailing Address - Country:US
Mailing Address - Phone:703-200-8695
Mailing Address - Fax:
Practice Address - Street 1:4460 BROOKFIELD CORPORATE DR STE H
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1671
Practice Address - Country:US
Practice Address - Phone:703-200-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional