Provider Demographics
NPI:1730425018
Name:ROGERS, LAKEISHA G (PHD, LCMHC, LCAS,CRC)
Entity type:Individual
Prefix:DR
First Name:LAKEISHA
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, LCMHC, LCAS,CRC
Other - Prefix:DR
Other - First Name:KEISHA
Other - Middle Name:G
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCMHC, LCAS,CRC
Mailing Address - Street 1:1 KENTBURY CIR # 215
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9340
Mailing Address - Country:US
Mailing Address - Phone:336-663-8017
Mailing Address - Fax:336-232-9454
Practice Address - Street 1:5 CENTERVIEW DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-663-8017
Practice Address - Fax:336-232-9454
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2718101YA0400X
NC10662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)