Healthcare Provider Details

I. General information

NPI: 1568682433
Provider Name (Legal Business Name): JENNIFER MICHELE ROGERS BA, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 HWY 421 S.
BUIES CREEK NC
27506
US

IV. Provider business mailing address

37 CHARLOTTE ST
CAMERON NC
28326-6326
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-5727
  • Fax: 910-893-6404
Mailing address:
  • Phone: 304-542-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: