Provider Demographics
NPI:1073668828
Name:ROSCOE, NASHEE
Entity Type:Individual
Prefix:
First Name:NASHEE
Middle Name:
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 RAVEN RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6773
Mailing Address - Country:US
Mailing Address - Phone:301-254-1244
Mailing Address - Fax:
Practice Address - Street 1:2231 RAVEN RD UNIT 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6773
Practice Address - Country:US
Practice Address - Phone:301-254-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCC0055471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical