Healthcare Provider Details

I. General information

NPI: 1649391939
Provider Name (Legal Business Name): OASIS CLINICAL CARE MANAGEMENT & CONSULTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 POSTAGE WAY #1772
INDIAN TRAIL NC
28079-9701
US

IV. Provider business mailing address

1006 SEBASTIAN CT
INDIAN TRAIL NC
28079-3688
US

V. Phone/Fax

Practice location:
  • Phone: 980-338-5563
  • Fax: 704-228-0268
Mailing address:
  • Phone: 980-328-3490
  • Fax: 800-853-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: THEODUS ROACH
Title or Position: OWNER
Credential:
Phone: 980-328-3490