Provider Demographics
NPI:1093291403
Name:ROCHE, ELISE IRENE (MS)
Entity Type:Individual
Prefix:MISS
First Name:ELISE
Middle Name:IRENE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 FAYETTEVILLE RD SE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2932
Mailing Address - Country:US
Mailing Address - Phone:404-324-4192
Mailing Address - Fax:
Practice Address - Street 1:1017 FAYETTEVILLE RD SE STE B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2932
Practice Address - Country:US
Practice Address - Phone:404-324-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor