Healthcare Provider Details

I. General information

NPI: 1740285691
Provider Name (Legal Business Name): ROGER LAPLACE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 1ST ST SW
ROANOKE VA
24016-4701
US

IV. Provider business mailing address

1115 1ST ST SW
ROANOKE VA
24016-4701
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-0004
  • Fax: 540-343-1576
Mailing address:
  • Phone: 540-343-0004
  • Fax: 540-343-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001119
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: