Provider Demographics
NPI:1013497692
Name:ROGERS, VICTORIA (LCPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 RITCHIE HWY STE 2001
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4163
Mailing Address - Country:US
Mailing Address - Phone:667-500-4556
Mailing Address - Fax:
Practice Address - Street 1:819 RITCHIE HWY STE 2001
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4163
Practice Address - Country:US
Practice Address - Phone:667-500-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional