Provider Demographics
NPI:1568071066
Name:PEREZ, ROCIO (LCMHC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCMHC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ARDEN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6888
Mailing Address - Country:US
Mailing Address - Phone:336-512-7583
Mailing Address - Fax:
Practice Address - Street 1:1606 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3518
Practice Address - Country:US
Practice Address - Phone:336-214-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional