Healthcare Provider Details

I. General information

NPI: 1043497704
Provider Name (Legal Business Name): JAMES MICHAEL ROVARIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL ROVARIS LCSW

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13237 ASHFORD PARK DR
RALEIGH NC
27613-4146
US

IV. Provider business mailing address

13237 ASHFORD PARK DR
RALEIGH NC
27613-4146
US

V. Phone/Fax

Practice location:
  • Phone: 719-238-4009
  • Fax: 919-841-4892
Mailing address:
  • Phone: 719-238-4009
  • Fax: 919-841-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number689
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007874
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: