MEDICARE: MR. KEITH POCHE LCSW

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	1041C0700X	Clinical Social Worker	0904010643	VA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-22976	NC
3	1041C0700X	Clinical Social Worker
4	1041C0700X	Clinical Social Worker	C010128	NC
5	101YA0400X	Addiction (Substance Use Disorder) Counselor	0718000684	VA

General Provider Information

NPI Number	:	1518025956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH POCHE LCSW

Provider Business Mailing Address
First Line	:	608 JACKSON ST STE 212
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-2600
Country	:	US
Telephone Number	:	919-200-5217
Fax Number	:	252-650-2214

Provider Business Practice Location Address
First Line	:	608 JACKSON ST STE 212
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-2600
Country	:	US
Telephone Number	:	919-200-5217
Fax Number	:	252-541-4002

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/03/2025

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Directions to “ MR. KEITH POCHE LCSW” Practice Location

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