Provider Demographics
NPI:1821355645
Name:ROGERS, STEPHEN D (LPC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CANTERBURY PL SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-8549
Mailing Address - Country:US
Mailing Address - Phone:706-331-2892
Mailing Address - Fax:
Practice Address - Street 1:12 CANTERBURY PL SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-8549
Practice Address - Country:US
Practice Address - Phone:706-331-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional