Provider Demographics
NPI:1306190772
Name:ROACH, LAURA C (LCMHC, MDIV)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCMHC, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3715
Mailing Address - Country:US
Mailing Address - Phone:828-260-7184
Mailing Address - Fax:
Practice Address - Street 1:136 PEARSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3715
Practice Address - Country:US
Practice Address - Phone:828-260-7184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9682101YP2500X
NC9682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional