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General NPI Number Information
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NPI Number | 1730849373
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Entity Type | Organization
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Legal Business Name | THE KGR GROUP PLLC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 5 CENTERVIEW DR STE 110
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City | GREENSBORO
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State | NC
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Zip | 27407-3709
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Country | US
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Telephone | 336-534-5172
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Fax | 336-232-9454
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Provider Business Mailing Address
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Address Line | 1 KENTBURY CIR
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City | GREENSBORO
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State | NC
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Zip | 27406-9340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAKEISHA ROGERS
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Credential | PHD,LCMHC,LCAS,CRC
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Telephone | 336-534-5172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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