MEDICARE: DR. GABRIEL LAVAN ROGERS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4666	NC

General Provider Information

NPI Number	:	1558551184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL LAVAN ROGERS PH.D.

Provider Business Mailing Address
First Line	:	2426 ROB ROY CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-7413
Country	:	US
Telephone Number	:	704-391-7598
Fax Number	:	704-398-0377

Provider Business Practice Location Address
First Line	:	4712 TUCKASEEGEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-2508
Country	:	US
Telephone Number	:	704-391-7598
Fax Number	:	704-398-0377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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