Provider Demographics
NPI:1568524957
Name:ROARK, SUSAN LESLIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LESLIE
Last Name:ROARK
Suffix:
Gender:F
Credentials:LPC
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Mailing Address - Street 1:918 9 1/2 STREET NE
Mailing Address - Street 2:SUSAN L ROARK LPC
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902
Mailing Address - Country:US
Mailing Address - Phone:434-296-3850
Mailing Address - Fax:434-296-2928
Practice Address - Street 1:918 9 1 2 ST NE
Practice Address - Street 2:SUSAN L ROARK LPC
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5311
Practice Address - Country:US
Practice Address - Phone:434-296-3850
Practice Address - Fax:434-296-2928
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701002014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
087527OtherSOUTHERN HEALTH
521336OtherVALUE OPTION
153886OtherANTHEM
IP287876OtherGREEN SPRING
5463577OtherAETNA