Provider Demographics
NPI:1386340933
Name:ROGERS, MARTINA NICOLE
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:NICOLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311206
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-1206
Mailing Address - Country:US
Mailing Address - Phone:334-797-9131
Mailing Address - Fax:
Practice Address - Street 1:430 OZARK RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-2600
Practice Address - Country:US
Practice Address - Phone:334-797-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health