Provider Demographics
NPI:1295211175
Name:ROVER, ANTONIA (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:
Last Name:ROVER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1964
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1964
Mailing Address - Country:US
Mailing Address - Phone:336-327-0849
Mailing Address - Fax:
Practice Address - Street 1:5000 WALLINGFORD DR APT B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5350
Practice Address - Country:US
Practice Address - Phone:336-327-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0125071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical