Individual
CAMILLA ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
121 N CENTER ST STE 202, STATESVILLE, NC 28677-5388
(704) 380-0436
(866) 950-6464
Mailing address
869 WENDOVER RD, STATESVILLE, NC 28677-3141
(704) 380-0436
(866) 950-6464
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
3551
NC
103T00000X
Psychologist
3551
NC
103TA0700X
Adult Development & Aging Psychologist
3551
NC
103TB0200X
Cognitive & Behavioral Psychologist
3551
NC
103TC0700X
Clinical Psychologist
Primary
3551
NC
103TP0814X
Psychoanalysis Psychologist
3551
NC
103TP2701X
Group Psychotherapy Psychologist
3551
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2826089
MEDICARE PTAN
NC
Enumeration date
08/01/2006
Last updated
06/05/2023
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