Provider Demographics
NPI:1336423953
Name:ROGERS, SHARLOTTE YVETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHARLOTTE
Middle Name:YVETTE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FLING RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3961
Mailing Address - Country:US
Mailing Address - Phone:706-302-1658
Mailing Address - Fax:
Practice Address - Street 1:406 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2232
Practice Address - Country:US
Practice Address - Phone:706-302-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003210065BMedicaid
GA003210065AMedicaid