Provider Demographics
NPI:1447891221
Name:ROGERS, JAMES LEE II (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:ROGERS
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JIMMY
Other - Middle Name:LEE
Other - Last Name:ROGERS
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:119 LINKS CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-4708
Mailing Address - Country:US
Mailing Address - Phone:601-940-8529
Mailing Address - Fax:
Practice Address - Street 1:1635 LELIA DR STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4876
Practice Address - Country:US
Practice Address - Phone:601-362-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2433101YA0400X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty