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General NPI Number Information
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NPI Number | 1477852440
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Entity Type | Individual
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Provider Name | MICHELLE LEE ROACH LPC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 1209A SEDGEFIELD ST
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City | DURHAM
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State | NC
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Zip | 27705-3545
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Country | US
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Telephone | 919-602-6439
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Fax |
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Provider Business Mailing Address
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Address Line | 4600 EMPEROR BLVD
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City | DURHAM
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State | NC
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Zip | 27703-8577
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Country | US
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Telephone | 919-651-8400
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8541
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License Number State | NC
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