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General NPI Number Information
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NPI Number | 1992912612
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Entity Type | Individual
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Provider Name | LAURICE DIANE ROGERS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1143 S 3RD ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2901
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Country | US
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Telephone | 502-581-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 105 TERRI ROSE CT
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City | HODGENVILLE
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State | KY
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Zip | 42748-9774
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Country | US
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Telephone | 270-358-0614
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 0043
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 060018
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License Number State | KY
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