Provider Demographics
NPI:1912459967
Name:ROGERS, PAMELA ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIZABETH
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 1:749 FLAT SHOALS AVE SE APT 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3860
Mailing Address - Country:US
Mailing Address - Phone:404-273-4388
Mailing Address - Fax:
Practice Address - Street 1:892 JEFFERSON ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5200
Practice Address - Country:US
Practice Address - Phone:404-273-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional