Healthcare Provider Details

I. General information

NPI: 1285643395
Provider Name (Legal Business Name): ROGER MALCOLM VOLK PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP, KADENA AB,
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 11541
APO AP
96367-0018
US

V. Phone/Fax

Practice location:
  • Phone: 01161457119580
  • Fax:
Mailing address:
  • Phone: 01161457119580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000797
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: