Provider Demographics
NPI:1235568718
Name:ROPER, ANTONIO (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:ROPER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 KELLERTON CT
Mailing Address - Street 2:
Mailing Address - City:WINNABOW
Mailing Address - State:NC
Mailing Address - Zip Code:28479-5198
Mailing Address - Country:US
Mailing Address - Phone:910-399-7589
Mailing Address - Fax:
Practice Address - Street 1:503 COVIL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2684
Practice Address - Country:US
Practice Address - Phone:910-332-5734
Practice Address - Fax:910-332-5739
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health