Provider Demographics
NPI:1477603827
Name:ROTH, NATALIE A (MA)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:A
Last Name:ROTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:398 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5196
Mailing Address - Country:US
Mailing Address - Phone:828-586-2311
Mailing Address - Fax:828-586-5450
Practice Address - Street 1:98D COPE CREEK RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-9508
Practice Address - Country:US
Practice Address - Phone:828-586-2311
Practice Address - Fax:828-586-5450
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2005-92103T00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY30615058Medicaid