Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3551 | NC |
N | 103T00000X | Psychologist | 3551 | NC |
N | 102L00000X | Psychologist | 3551 | NC |
N | 103T00000X | Psychologist | 3551 | NC |
N | 103TA0700X | Adult Development & Aging Psychologist | 3551 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3551 | NC |
Y | 103G00000X | Clinical Psychologist | 3551 | NC |
Y | 103TC0700X | Clinical Psychologist | 3551 | NC |
N | 103TP0814X | Psychoanalysis | 3551 | NC |
N | 103TP2701X | Group Psychotherapist | 3551 | NC |
NPI | 1174539688 |
---|---|
Provider Name | Camilla Rogers |
First Address | Davidson, NC 28036-6393 |
Second Address | Davidson, NC 28036-9402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2826089 | MEDICARE PTAN (01) | NC |