| Doctor Name: | MR. GREGORY ELLSWORTH ROGERS |
| NPI Number: | 1366784829 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A., L.C.A.S. |
| License Number: | LCAS #1725 |
| Business Practice Address: | 5841 Us Highway 421 South Buies Creek, NC - 27506 |
| Business Phone Number: | 9108935727 |
| Business Fax Number: | 9108936404 |
| Mailing Address: | 284 Executive Park Dr Ste 100, CONCORD |
| State: | NC |
| Postal Code: | 280251833 |
| Phone Number: | 7049391100 |
| Fax Number: | 7049391173 |
| NPI Enumeration Date: | 03/22/2013 |
| NPI Last Update Date: | 08/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCAS #1725 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |