Provider Demographics
NPI:1417474446
Name:ROGERS, NORIE CESCUTTI
Entity Type:Individual
Prefix:
First Name:NORIE
Middle Name:CESCUTTI
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 1:104 DANNY DR APT B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8772
Mailing Address - Country:US
Mailing Address - Phone:706-767-1769
Mailing Address - Fax:
Practice Address - Street 1:2717 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-9349
Practice Address - Country:US
Practice Address - Phone:470-244-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005913101YM0800X
GALPC011842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAKIS80203265000OtherCAPITAL BLUE