Provider Demographics
NPI:1689952053
Name:ROGERS, TRACI BRENNER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:BRENNER
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 1:138 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8309
Mailing Address - Country:US
Mailing Address - Phone:443-907-9074
Mailing Address - Fax:717-790-9268
Practice Address - Street 1:5249 SIMPSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3515
Practice Address - Country:US
Practice Address - Phone:717-487-5493
Practice Address - Fax:717-790-9268
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional