Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701004611 | VA |
NPI | 1003115874 |
---|---|
Provider Name | Mr. David James Rogers |
First Address | Richmond, VA 23233-3539 |
Second Address | Mechanicsville, VA 23116-6613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2011 |
Last Update Date | 30/11/2011 |