Provider Demographics
NPI:1710254586
Name:ROGERS, JERRY L (LICDC, LPCC-S)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LICDC, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED HARTMAN HWY
Mailing Address - Street 2:SUITE 133
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2830
Mailing Address - Country:US
Mailing Address - Phone:513-984-9838
Mailing Address - Fax:513-984-8075
Practice Address - Street 1:10921 REED HARTMAN HWY
Practice Address - Street 2:SUITE 133
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2830
Practice Address - Country:US
Practice Address - Phone:513-984-9838
Practice Address - Fax:513-984-8075
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161035101YA0400X, 101YA0400X
OHE.0900614-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)