Provider Demographics
NPI:1346868742
Name:ROACH, REGENIA E (LPC)
Entity Type:Individual
Prefix:
First Name:REGENIA
Middle Name:E
Last Name:ROACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 WILSON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1972
Mailing Address - Country:US
Mailing Address - Phone:713-835-0259
Mailing Address - Fax:
Practice Address - Street 1:10327 ROCKAWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3330
Practice Address - Country:US
Practice Address - Phone:713-835-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2020-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor