Provider Demographics
NPI:1235501495
Name:ROCHA, CHRISTIN (LCADC)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2501
Mailing Address - Country:US
Mailing Address - Phone:443-299-6766
Mailing Address - Fax:443-299-6668
Practice Address - Street 1:1803 HARFORD RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2501
Practice Address - Country:US
Practice Address - Phone:443-299-6766
Practice Address - Fax:443-299-6668
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)