Provider Demographics
NPI:1245401785
Name:ROACH, DEBORAH L (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:ROACH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:715 LANE ST
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-355-8606
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9300
Practice Address - Country:US
Practice Address - Phone:304-429-6755
Practice Address - Fax:304-429-7562
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0500643101YM0800X
OHI11015731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health