Provider Demographics
NPI:1043424435
Name:HYMAN, ROGER EARL JR (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:EARL
Last Name:HYMAN
Suffix:JR
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 HIGH MEADOWS DR APT B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4363
Mailing Address - Country:US
Mailing Address - Phone:336-837-8626
Mailing Address - Fax:
Practice Address - Street 1:3630 B HIGH MEADOWS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4363
Practice Address - Country:US
Practice Address - Phone:336-837-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional