Provider Demographics
NPI:1912564352
Name:ROSSER, DAVID ALLEN (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:ROSSER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-0818
Mailing Address - Country:US
Mailing Address - Phone:336-940-8690
Mailing Address - Fax:
Practice Address - Street 1:1365 MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028
Practice Address - Country:US
Practice Address - Phone:336-753-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional