Provider Demographics
NPI:1447304555
Name:ROGERS, ROLESIA RENEE (LCPC)
Entity type:Individual
Prefix:MS
First Name:ROLESIA
Middle Name:RENEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:ROLESIA
Other - Middle Name:RENEE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCADC
Mailing Address - Street 1:1383 DEANWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234
Mailing Address - Country:US
Mailing Address - Phone:410-499-1755
Mailing Address - Fax:
Practice Address - Street 1:1111 NORTH CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1623101YA0400X
MDLC5072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)