Provider Demographics
NPI:1629485529
Name:ROGERS, NICKIE CHALONDA (LPC)
Entity Type:Individual
Prefix:
First Name:NICKIE
Middle Name:CHALONDA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 OXFORD ST STE B
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3301
Mailing Address - Country:US
Mailing Address - Phone:803-774-6892
Mailing Address - Fax:803-774-6893
Practice Address - Street 1:529 OXFORD ST
Practice Address - Street 2:SUITE D
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3301
Practice Address - Country:US
Practice Address - Phone:803-774-0147
Practice Address - Fax:803-774-0149
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional