Provider Demographics
NPI:1528584596
Name:ROACH, RACHEL L
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2319
Mailing Address - Country:US
Mailing Address - Phone:864-898-5800
Mailing Address - Fax:864-898-5804
Practice Address - Street 1:309 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671
Practice Address - Country:US
Practice Address - Phone:864-898-5800
Practice Address - Fax:864-898-5804
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty