Healthcare Provider Details

I. General information

NPI: 1174080816
Provider Name (Legal Business Name): ROC WITH KNOWLEDGE & GRIT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 PROSPECT RD
DRY PRONG LA
71423-3479
US

IV. Provider business mailing address

259 PROSPECT RD
DRY PRONG LA
71423-3479
US

V. Phone/Fax

Practice location:
  • Phone: 318-955-8035
  • Fax:
Mailing address:
  • Phone: 318-955-8035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: DR. RITA DARLENE MARTIN
Title or Position: ADMINISTRATOR/SECRETARY
Credential: LPC
Phone: 318-955-8035