Provider Demographics
NPI:1811222342
Name:DONNA R B ROGERS PLLC
Entity Type:Organization
Organization Name:DONNA R B ROGERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:RB
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-802-0312
Mailing Address - Street 1:3317 PROSPECT PKWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8359
Mailing Address - Country:US
Mailing Address - Phone:702-374-3282
Mailing Address - Fax:919-800-3060
Practice Address - Street 1:1140 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9634
Practice Address - Country:US
Practice Address - Phone:919-802-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602088Medicaid
NC4436OtherNC STATE LICENSE
NV002602088Medicaid