Healthcare Provider Details

I. General information

NPI: 1003720178
Provider Name (Legal Business Name): RODERICK EUGENE ROGERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 PENINSULA CT
ORANGEBURG SC
29118-2622
US

IV. Provider business mailing address

373 PENINSULA CT
ORANGEBURG SC
29118-2622
US

V. Phone/Fax

Practice location:
  • Phone: 803-968-6421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: