Healthcare Provider Details

I. General information

NPI: 1225324965
Provider Name (Legal Business Name): GENEVIEVE ROIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LIONS DR 221
BARRINGTON IL
60010-3182
US

IV. Provider business mailing address

111 LIONS DR 221
BARRINGTON IL
60010-3182
US

V. Phone/Fax

Practice location:
  • Phone: 224-465-8870
  • Fax:
Mailing address:
  • Phone: 224-465-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.005999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: