Individual
MR. MARK ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC,LBSW
Contact information
Practice address
7027 MELDRUM RD, IRA, MI 48023-2427
(586) 725-0560
Mailing address
7027 MELDRUM, FAIR HAVEN, MI 48023
(586) 725-0560
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401000566
MI
1041C0700X
Clinical Social Worker
6802062229
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
STOOLMANLPC4
—
MI
Enumeration date
10/22/2013
Last updated
10/22/2013
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