Individual
NICOLE ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
3222 N 37TH ST, PHOENIX, AZ 85018-6304
(602) 599-5554
(602) 599-5854
Mailing address
3710 W GREENWAY RD STE 104, PHOENIX, AZ 85053-3729
(602) 466-2036
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/10/2014
Last updated
09/29/2021
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