Provider Demographics
NPI:1598247678
Name:ROACH, AARON (MA, LPCA)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:ROACH
Suffix:
Gender:M
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 FAIRWAY RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8106
Mailing Address - Country:US
Mailing Address - Phone:704-756-2116
Mailing Address - Fax:
Practice Address - Street 1:170 DAVIDSON HWY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4245
Practice Address - Country:US
Practice Address - Phone:980-209-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty