Basic Information
| Provider Information | |||||||||
| NPI: | 1154785889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 WALNUT ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284014063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103336134 | ||||||||
| FaxNumber: | 9103434227 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 WALNUT ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284014160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103336134 | ||||||||
| FaxNumber: | 9103434227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2016 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LCAS-22306 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 12458 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 12458 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.