Provider Demographics
NPI:1790995520
Name:ROCHE, ANNE MILLICENT (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MILLICENT
Last Name:ROCHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MILLICENT
Other - Middle Name:
Other - Last Name:ROCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2052 MCLENDON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1808
Mailing Address - Country:US
Mailing Address - Phone:404-668-7331
Mailing Address - Fax:
Practice Address - Street 1:2052 MCLENDON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1808
Practice Address - Country:US
Practice Address - Phone:404-668-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical