Provider Demographics
NPI:1780751412
Name:ROGERS, KELLIE HEBERT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:HEBERT
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 PARTIN DR N STE 1
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1426
Mailing Address - Country:US
Mailing Address - Phone:850-729-0303
Mailing Address - Fax:850-729-0305
Practice Address - Street 1:1417 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1430
Practice Address - Country:US
Practice Address - Phone:850-729-0303
Practice Address - Fax:850-729-0305
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL175641041C0700X
LA58471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical