MEDICARE: DEANNA ROCK LCMHC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8554	SC
2	101YM0800X	Mental Health Counselor	20328	NC

General Provider Information

NPI Number	:	1073182945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA ROCK LCMHC, LPC

Provider Business Mailing Address
First Line	:	5586 US HIGHWAY 21 S
Second Line	:
City	:	GLADE VALLEY
State	:	NC
Zip	:	28627-8912
Country	:	US
Telephone Number	:	803-920-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 TIMBER CREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9211
Country	:	US
Telephone Number	:	803-920-1505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	12/16/2025

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