Provider Demographics
NPI:1760164743
Name:ROARK, FELICIA ANN (MSW)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANN
Last Name:ROARK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8571
Mailing Address - Country:US
Mailing Address - Phone:304-746-5300
Mailing Address - Fax:
Practice Address - Street 1:700 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8571
Practice Address - Country:US
Practice Address - Phone:304-746-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009453041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical