Provider Demographics
NPI:1053597492
Name:ROGERS, JESSICA RASHADA-JAMILLAH (MS)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RASHADA-JAMILLAH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 CROWNE LAKE CIRCLE
Mailing Address - Street 2:APT 2F
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-7931
Mailing Address - Country:US
Mailing Address - Phone:336-772-4423
Mailing Address - Fax:
Practice Address - Street 1:4505 CROWNE LAKE CIRCLE
Practice Address - Street 2:APT 2F
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-7931
Practice Address - Country:US
Practice Address - Phone:336-772-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health