Provider Demographics
NPI:1700996048
Name:ROHRER, MARK ALAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:ROHRER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6046 14TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7340
Mailing Address - Country:US
Mailing Address - Phone:701-404-0997
Mailing Address - Fax:701-566-8876
Practice Address - Street 1:6046 14TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7340
Practice Address - Country:US
Practice Address - Phone:701-404-0997
Practice Address - Fax:701-566-8876
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND606OtherSTATE LICENSE NMBR LICSW