Provider Demographics
NPI:1376255331
Name:ROGERS, EVELYN DELORIS (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DELORIS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NEWPORT BLVD UNIT 1108
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-9818
Mailing Address - Country:US
Mailing Address - Phone:912-665-8038
Mailing Address - Fax:
Practice Address - Street 1:7308 E INDEPENDENCE BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9440
Practice Address - Country:US
Practice Address - Phone:980-254-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical