Provider Demographics
NPI:1497823355
Name:ROUNTREE, ALAN (PSYD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1564
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-1564
Mailing Address - Country:US
Mailing Address - Phone:757-923-3025
Mailing Address - Fax:757-923-3046
Practice Address - Street 1:440 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5238
Practice Address - Country:US
Practice Address - Phone:757-923-3025
Practice Address - Fax:757-923-3046
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical