Healthcare Provider Details

I. General information

NPI: 1912064387
Provider Name (Legal Business Name): SUSAN ROISTACHER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N ADAMS ST
ROCKVILLE MD
20850-1829
US

IV. Provider business mailing address

206 N ADAMS ST
ROCKVILLE MD
20850-1829
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-0920
  • Fax: 301-424-4333
Mailing address:
  • Phone: 301-424-0920
  • Fax: 301-424-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC0004
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0004
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: