Provider Demographics
NPI:1134160476
Name:ROCHELLE, JOSEPH LEE JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:ROCHELLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7741 MARKET ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9444
Mailing Address - Country:US
Mailing Address - Phone:910-686-3505
Mailing Address - Fax:910-686-3505
Practice Address - Street 1:7741 MARKET ST
Practice Address - Street 2:UNIT C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9444
Practice Address - Country:US
Practice Address - Phone:910-686-3505
Practice Address - Fax:910-686-3505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102035Medicaid
NC135JTOtherBCBSNC