Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 10433 | TX |
Y | 101YP2500X | Professional Counselor | 74820 | TX |
NPI | 1003289216 |
---|---|
Provider Name | Charity Rogers |
First Address | Paige, TX 78659-0069 |
Second Address | Paige, TX 78659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2015 |
Last Update Date | 14/05/2021 |