Provider Demographics
NPI:1619464500
Name:ROGERS, ANASTACIA MARY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANASTACIA
Middle Name:MARY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580-0169
Mailing Address - Country:US
Mailing Address - Phone:205-686-5113
Mailing Address - Fax:205-686-5145
Practice Address - Street 1:5947 HIGHWAY 269
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:AL
Practice Address - Zip Code:35580-3847
Practice Address - Country:US
Practice Address - Phone:205-686-5113
Practice Address - Fax:205-265-2994
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4342G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4342GOtherALABAMA STATE BOARD OF SOCIAL WORKERS