Provider Demographics
NPI:1265868699
Name:ROGERS, SANDY CHEREYLE (PHD, HS-BCP)
Entity type:Individual
Prefix:MISS
First Name:SANDY
Middle Name:CHEREYLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, HS-BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 RED BERRY CIR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-4944
Mailing Address - Country:US
Mailing Address - Phone:843-647-7418
Mailing Address - Fax:
Practice Address - Street 1:3059 RED BERRY CIR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541-4944
Practice Address - Country:US
Practice Address - Phone:843-647-7418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 101Y00000X
SC1270171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor