Provider Demographics
NPI:1356076483
Name:ROGICH, KAREN DEBORAH (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DEBORAH
Last Name:ROGICH
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5341
Mailing Address - Country:US
Mailing Address - Phone:704-277-5942
Mailing Address - Fax:
Practice Address - Street 1:1816 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2416
Practice Address - Country:US
Practice Address - Phone:704-313-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17773101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor