Healthcare Provider Details

I. General information

NPI: 1245455294
Provider Name (Legal Business Name): TEMIKA ROGERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 W 6TH AVE
PINE BLUFF AR
71601-4031
US

IV. Provider business mailing address

PO BOX 1926
PINE BLUFF AR
71613-1926
US

V. Phone/Fax

Practice location:
  • Phone: 870-568-4502
  • Fax: 870-395-7086
Mailing address:
  • Phone: 870-718-2349
  • Fax: 870-395-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5469-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: