Provider Demographics
NPI:1497456065
Name:KING-EAGLES, ROGSBERT FRENZELL (LADC)
Entity type:Individual
Prefix:
First Name:ROGSBERT
Middle Name:FRENZELL
Last Name:KING-EAGLES
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ROGSBERT
Other - Middle Name:FRENZELL
Other - Last Name:KING-EAGLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:950 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5158
Mailing Address - Country:US
Mailing Address - Phone:203-923-6474
Mailing Address - Fax:
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5158
Practice Address - Country:US
Practice Address - Phone:203-923-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)