Provider Demographics
NPI:1790562353
Name:ROGERS, DESHONA
Entity Type:Individual
Prefix:
First Name:DESHONA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 SHILLINGLAW RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-6342
Mailing Address - Country:US
Mailing Address - Phone:252-277-0143
Mailing Address - Fax:
Practice Address - Street 1:2870 SHILLINGLAW RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-6342
Practice Address - Country:US
Practice Address - Phone:252-277-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician