Provider Demographics
NPI:1932784725
Name:COSTLEY, ROXANNE N (MA, LPC RESIDENT)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:N
Last Name:COSTLEY
Suffix:
Gender:F
Credentials:MA, LPC RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 STONEY PT N
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3923
Mailing Address - Country:US
Mailing Address - Phone:757-506-1151
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE BLVD STE 532
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5473
Practice Address - Country:US
Practice Address - Phone:757-962-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011553101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor