Healthcare Provider Details

I. General information

NPI: 1114270998
Provider Name (Legal Business Name): JARED STEWART ROE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940B GILBERT FERRY RD SE
ATTALLA AL
35954-3338
US

IV. Provider business mailing address

2160 FOUNTAIN DR
SNELLVILLE GA
30078-7022
US

V. Phone/Fax

Practice location:
  • Phone: 256-579-6011
  • Fax: 256-302-8046
Mailing address:
  • Phone: 770-985-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7818
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2376C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: