Provider Demographics
NPI:1245455294
Name:ROGERS, TEMIKA (LCSW)
Entity type:Individual
Prefix:
First Name:TEMIKA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1926
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1926
Mailing Address - Country:US
Mailing Address - Phone:870-718-2349
Mailing Address - Fax:870-395-7086
Practice Address - Street 1:813 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4031
Practice Address - Country:US
Practice Address - Phone:870-568-4502
Practice Address - Fax:870-395-7086
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5469-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR395982YXDKMedicaid