Healthcare Provider Details

I. General information

NPI: 1184236408
Provider Name (Legal Business Name): HEATHER ROGERO MA, REV. (LPC), PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER HARRINGTON MA, REV.

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 NORTHPOINTE DR
MOUNTAIN HOME AR
72653-8126
US

IV. Provider business mailing address

990 NORTHPOINTE DR
MOUNTAIN HOME AR
72653-8126
US

V. Phone/Fax

Practice location:
  • Phone: 202-505-9992
  • Fax:
Mailing address:
  • Phone: 202-505-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2551489
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2551489
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2551489
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberST-390200000X
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number85911320200809
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2551489
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: