Provider Demographics
NPI:1952896227
Name:ROGERS, LASHAWN MONIQUE (MS, BA, CIT-AD)
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:MONIQUE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS, BA, CIT-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 TAYLOR AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8328
Mailing Address - Country:US
Mailing Address - Phone:410-617-0280
Mailing Address - Fax:410-323-3544
Practice Address - Street 1:1045 TAYLOR AVE STE 10
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8328
Practice Address - Country:US
Practice Address - Phone:410-617-0280
Practice Address - Fax:410-323-3544
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT1290101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD822572875Medicaid