Provider Demographics
NPI:1174653307
Name:ROACH, SHAWN B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:B
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 EMORY VALLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7746
Mailing Address - Country:US
Mailing Address - Phone:865-482-9252
Mailing Address - Fax:865-482-9252
Practice Address - Street 1:685 EMORY VALLEY RD STE C
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7746
Practice Address - Country:US
Practice Address - Phone:865-482-9252
Practice Address - Fax:865-482-7164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical