Provider Demographics
NPI:1437421419
Name:RODGERS, BEVERLY (MFT, PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 JULES CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8908
Mailing Address - Country:US
Mailing Address - Phone:704-364-9175
Mailing Address - Fax:704-366-0729
Practice Address - Street 1:6412 BANNINGTON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1327
Practice Address - Country:US
Practice Address - Phone:704-364-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLMFT 427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist