Provider Demographics
NPI:1689070435
Name:ROARK, AMBER LOU (LCSW,LCAC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LOU
Last Name:ROARK
Suffix:
Gender:F
Credentials:LCSW,LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 SISKIYOU BLVD STE 2027
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2336
Mailing Address - Country:US
Mailing Address - Phone:855-478-4357
Mailing Address - Fax:
Practice Address - Street 1:8520 ALLISON POINTE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:855-478-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000663A101YA0400X
IN33006295A104100000X
IN34008575A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker