Provider Demographics
NPI:1558789438
Name:POERIO, ROCHELLE (LADC, LADC-S, MAC)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:POERIO
Suffix:
Gender:F
Credentials:LADC, LADC-S, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 RANGER WAY
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-0920
Mailing Address - Country:US
Mailing Address - Phone:702-600-2527
Mailing Address - Fax:
Practice Address - Street 1:2050 N HIGHWAY 160 STE 600
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-5408
Practice Address - Country:US
Practice Address - Phone:775-505-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01501-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)