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General NPI Number Information
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NPI Number | 1720728702
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Entity Type | Individual
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Provider Name | SAMARRA ROGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 7309 JACKSON ARCH DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-4722
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Country | US
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Telephone | 804-306-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 8050 MECHANICSVILLE TPKE UNIT 614
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1278
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Country | US
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Telephone | 804-306-0112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904013858
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License Number State | VA
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