Provider Demographics
NPI:1023744380
Name:ROGERS, PATRICIA WHITE (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WHITE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:S
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0607
Mailing Address - Country:US
Mailing Address - Phone:601-859-9888
Mailing Address - Fax:
Practice Address - Street 1:1171 HART ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4805
Practice Address - Country:US
Practice Address - Phone:601-859-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS15405Other261QR1300X - CLINIC/CENTER RURAL HEALTH