Provider Demographics
NPI:1922681345
Name:ROGERS, MARLANA E'LAN PETERSON (CADC)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:E'LAN PETERSON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 KINNAKEET DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5275
Mailing Address - Country:US
Mailing Address - Phone:516-698-1901
Mailing Address - Fax:
Practice Address - Street 1:880 MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2600
Practice Address - Country:US
Practice Address - Phone:516-698-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)