Provider Demographics
NPI:1891243523
Name:ROGERS, SHARON WEST (DMIN)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:WEST
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 ABERCORN AVE
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1642
Mailing Address - Country:US
Mailing Address - Phone:202-556-0769
Mailing Address - Fax:855-512-8221
Practice Address - Street 1:797 ROSWELL ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2134
Practice Address - Country:US
Practice Address - Phone:202-556-0769
Practice Address - Fax:855-512-8221
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004718101YM0800X, 101Y00000X, 101YP2500X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral