Provider Demographics
NPI:1497399513
Name:ROGERS, LAVENDA T (MSW, ,LCSWA ,LLMSW)
Entity Type:Individual
Prefix:
First Name:LAVENDA
Middle Name:T
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW, ,LCSWA ,LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 REHOBETH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8014
Mailing Address - Country:US
Mailing Address - Phone:910-801-4567
Mailing Address - Fax:
Practice Address - Street 1:142 REHOBETH CHURCH RD
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-8014
Practice Address - Country:US
Practice Address - Phone:910-801-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511152711041C0700X
NCP0182941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1025Medicaid