Healthcare Provider Details

I. General information

NPI: 1770223372
Provider Name (Legal Business Name): EMMANUEL L. ROCK MS, LPC, NCC,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/20/2024
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NOBLE ST STE 710
ANNISTON AL
36201-5698
US

IV. Provider business mailing address

801 NOBLE ST STE 710
ANNISTON AL
36201-5698
US

V. Phone/Fax

Practice location:
  • Phone: 256-273-9369
  • Fax: 256-253-5541
Mailing address:
  • Phone: 256-273-9369
  • Fax: 256-253-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4082A
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05275
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: