Provider Demographics
NPI:1760261374
Name:ROHRBACK, ANNE MARIE (EDS)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:ROHRBACK
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2154
Mailing Address - Country:US
Mailing Address - Phone:970-903-8455
Mailing Address - Fax:
Practice Address - Street 1:209 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-2154
Practice Address - Country:US
Practice Address - Phone:970-903-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24427809103TS0200X
SC315434103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool