Provider Demographics
NPI:1396367298
Name:CLARKE, ROCHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:CLARKE
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 1:12511 CRYSTAL DOWNS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8601
Mailing Address - Country:US
Mailing Address - Phone:804-519-3971
Mailing Address - Fax:
Practice Address - Street 1:12511 CRYSTAL DOWNS LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8601
Practice Address - Country:US
Practice Address - Phone:804-519-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health