Provider Demographics
NPI:1780025239
Name:BANKS ROGERS, PATRICE SUZETE (LPCA)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:SUZETE
Last Name:BANKS ROGERS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:SUZETTE
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:111 CINDER ST
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6001
Mailing Address - Country:US
Mailing Address - Phone:919-886-8519
Mailing Address - Fax:919-890-0389
Practice Address - Street 1:111 CINDER ST
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6001
Practice Address - Country:US
Practice Address - Phone:919-886-8519
Practice Address - Fax:919-890-0389
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8235101YM0800X, 101YP2500X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA8235OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE