Provider Demographics
NPI:1902291545
Name:ROGERS, ASHLEY HAYES
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HAYES
Last Name:ROGERS
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 1:9305 MONROE RD STE L
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1490
Mailing Address - Country:US
Mailing Address - Phone:980-819-0010
Mailing Address - Fax:
Practice Address - Street 1:9305 MONROE RD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1490
Practice Address - Country:US
Practice Address - Phone:980-819-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-15-18512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst