Provider Demographics
NPI:1871133926
Name:ROGERSON, EVE
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 SAM NEWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5072
Mailing Address - Country:US
Mailing Address - Phone:980-215-9296
Mailing Address - Fax:
Practice Address - Street 1:1146 SAM NEWELL RD STE D
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5072
Practice Address - Country:US
Practice Address - Phone:980-215-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health