Healthcare Provider Details

I. General information

NPI: 1891243523
Provider Name (Legal Business Name): SHARON WEST ROGERS D.MIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 ROSWELL ST NE
MARIETTA GA
30060-2134
US

IV. Provider business mailing address

6421 ABERCORN AVE
DUNWOODY GA
30346-1642
US

V. Phone/Fax

Practice location:
  • Phone: 202-556-0769
  • Fax: 855-512-8221
Mailing address:
  • Phone: 202-556-0769
  • Fax: 855-512-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC004718
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC004718
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC004718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: