Provider Demographics
NPI:1306176490
Name:ROCHE, CAROLYN PENDER (PHD, NCSP)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:PENDER
Last Name:ROCHE
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 HIGHGATE DR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6630
Mailing Address - Country:US
Mailing Address - Phone:919-228-8845
Mailing Address - Fax:
Practice Address - Street 1:5318 HIGHGATE DR
Practice Address - Street 2:SUITE 132
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6630
Practice Address - Country:US
Practice Address - Phone:919-228-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3845103G00000X, 103TC0700X, 103TF0000X, 103TS0200X
3845103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool