1760766398 NPI number — SHAROLETTE ROGERS COUNSELING SERVICES, LLC

Table of content: DR. LISA DANIELLE BELLAH PH.D. (NPI 1891020541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760766398 NPI number — SHAROLETTE ROGERS COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAROLETTE ROGERS COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760766398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 GORDON COMMERCIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30240-5735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-302-1658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 GORDON COMMERCIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-302-1658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
SHAROLETTE
Authorized Official Middle Name:
YVETTE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-302-1658

Provider Taxonomy Codes

  • Taxonomy code: 3245S0500X , with the licence number:  LPC005338 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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