Provider Demographics
NPI:1558790360
Name:ROGERS, JACQUELINE N (LCPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 PISCATAWAY ROAD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-868-0400
Mailing Address - Fax:301-868-9000
Practice Address - Street 1:9135 PISCATAWAY ROAD
Practice Address - Street 2:SUITE 340
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-868-0400
Practice Address - Fax:301-868-9000
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006398101YP2500X
MDLC5376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR-262-356-622-254OtherDRIVERS LICENSE