Provider Demographics
NPI:1073037271
Name:ROGERS, KIM ROBERT (LMFT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ROBERT
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 PROSPECT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8359
Mailing Address - Country:US
Mailing Address - Phone:702-374-3284
Mailing Address - Fax:919-800-3060
Practice Address - Street 1:1140 HOLLY SPRINGS ROAD #207
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:702-374-3284
Practice Address - Fax:919-800-3060
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-29
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty