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General NPI Number Information
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NPI Number | 1336311174
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Entity Type | Individual
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Provider Name | LAHOMA T ROEBUCK MSW,LCSW,LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 1322 W MAIN
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City | ANTLERS
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State | OK
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Zip | 74523-1322
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Country | US
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Telephone | 580-298-5062
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Fax | 580-298-9958
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Provider Business Mailing Address
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Address Line | 1322 W. MAIN
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City | ANTLERS
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State | OK
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Zip | 74523-1322
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Country | US
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Telephone | 580-298-5062
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Fax | 580-298-9958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11196
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3668
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License Number State | OK
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