Provider Demographics
NPI:1710308861
Name:SUSAN K ROEHRICH LLC
Entity Type:Organization
Organization Name:SUSAN K ROEHRICH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-616-2230
Mailing Address - Street 1:300 ENTERPRISE DR STE C
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2732
Mailing Address - Country:US
Mailing Address - Phone:434-616-2230
Mailing Address - Fax:434-616-2232
Practice Address - Street 1:300 ENTERPRISE DR STE C
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2732
Practice Address - Country:US
Practice Address - Phone:434-616-2230
Practice Address - Fax:434-616-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5405955Medicaid