Provider Demographics
NPI:1235775040
Name:CAROLYN ROATH, PLLC
Entity Type:Organization
Organization Name:CAROLYN ROATH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROATH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-242-4426
Mailing Address - Street 1:5505 STAR FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8695
Mailing Address - Country:US
Mailing Address - Phone:517-242-4426
Mailing Address - Fax:
Practice Address - Street 1:5505 STAR FLOWER DR
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8695
Practice Address - Country:US
Practice Address - Phone:517-242-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty