Provider Demographics
NPI:1760196778
Name:ROGERS, KEIANA C (CDCA)
Entity Type:Individual
Prefix:
First Name:KEIANA
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 TOWNVISTA DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1717
Mailing Address - Country:US
Mailing Address - Phone:513-295-6696
Mailing Address - Fax:
Practice Address - Street 1:3270 NORTH BEND RD STE 209
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7611
Practice Address - Country:US
Practice Address - Phone:513-781-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.182401101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty