Provider Demographics
NPI:1770223372
Name:ROCK, EMMANUEL L (MS, ALC, NCC)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:L
Last Name:ROCK
Suffix:
Gender:M
Credentials:MS, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 QUILL AVE NW APT 61
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1460
Mailing Address - Country:US
Mailing Address - Phone:205-362-7124
Mailing Address - Fax:
Practice Address - Street 1:400 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4716
Practice Address - Country:US
Practice Address - Phone:256-273-9369
Practice Address - Fax:256-624-6810
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC4082A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health