MEDICARE: EVELYN DELORIS ROGERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C019097	NC
2	1041C0700X	Clinical Social Worker	P018553	NC
3	1041C0700X	Clinical Social Worker	CSW010034	GA

General Provider Information

NPI Number	:	1376255331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN DELORIS ROGERS LCSW

Provider Business Mailing Address
First Line	:	1503 RIDDICK LN
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-4088
Country	:	US
Telephone Number	:	912-665-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S MCDOWELL ST STE 125-2526
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2623
Country	:	US
Telephone Number	:	912-482-2182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	02/18/2026

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