Provider Demographics
NPI:1952432007
Name:ROGERS, CARLA JEAN (MSW, LCSW, BAS)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSW, LCSW, BAS
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:JEAN
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74425-0294
Mailing Address - Country:US
Mailing Address - Phone:918-429-5496
Mailing Address - Fax:
Practice Address - Street 1:500 EUNICE BURNS RD DEPT OF
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-4052
Practice Address - Country:US
Practice Address - Phone:918-618-2168
Practice Address - Fax:918-618-4412
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical