Healthcare Provider Details

I. General information

NPI: 1023055621
Provider Name (Legal Business Name): ERIN LEE WORTHINGTON-ROACH CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 ELLERTON DR
MIDLOTHIAN VA
23113-3669
US

IV. Provider business mailing address

3601 ELLERTON DR
MIDLOTHIAN VA
23113-3669
US

V. Phone/Fax

Practice location:
  • Phone: 410-960-0879
  • Fax:
Mailing address:
  • Phone: 410-960-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006856
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: