Provider Demographics
NPI:1891829982
Name:ROGERS, CYNTHIA (LPC, LCAS, CCS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 E ELIZABETHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3225
Mailing Address - Country:US
Mailing Address - Phone:910-738-7880
Mailing Address - Fax:910-738-7882
Practice Address - Street 1:302 EAST THIRD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-2883
Practice Address - Country:US
Practice Address - Phone:910-521-1464
Practice Address - Fax:910-521-1852
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC973101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111874Medicaid