Healthcare Provider Details

I. General information

NPI: 1174828933
Provider Name (Legal Business Name): ERIN BOSWELL ROGERS MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 MEMPHIS ST
HERNANDO MS
38632-1703
US

IV. Provider business mailing address

523 LORELL TER
SANDY SPRINGS GA
30328-4115
US

V. Phone/Fax

Practice location:
  • Phone: 901-826-1560
  • Fax:
Mailing address:
  • Phone: 901-826-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1309
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: