Healthcare Provider Details

I. General information

NPI: 1376276535
Provider Name (Legal Business Name): JAMES ROGERS JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

IV. Provider business mailing address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224386
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: