Provider Demographics
NPI:1518544865
Name:ROYBAL DE DIAZ, ROXANNE (MA, LPC NCC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:ROYBAL DE DIAZ
Suffix:
Gender:F
Credentials:MA, LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 PINE LOG RD # 1190
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7330
Mailing Address - Country:US
Mailing Address - Phone:803-265-2184
Mailing Address - Fax:
Practice Address - Street 1:SEEADLERWEG 6
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VIENNA
Practice Address - Zip Code:A1220
Practice Address - Country:AT
Practice Address - Phone:803-265-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC6523PC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional