Healthcare Provider Details

I. General information

NPI: 1285839563
Provider Name (Legal Business Name): LOU WINGO ROGERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GREENVILLE DRIVE
WILLIAMSTON SC
29697
US

IV. Provider business mailing address

13 FLINTLOCK CT
GREENVILLE SC
29611-7406
US

V. Phone/Fax

Practice location:
  • Phone: 864-847-1818
  • Fax:
Mailing address:
  • Phone: 864-269-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2461
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: