| Doctor Name: | MR. MICHAEL ROE |
| NPI Number: | 1134475452 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, LCPC |
| License Number: | 180.007091 |
| Business Practice Address: | 1200 Ring Rd 2454 Calumet City, IL - 604097200 |
| Business Phone Number: | 7088988745 |
| Business Fax Number: | |
| Mailing Address: | 1200 Ring Rd, 2454 CALUMET CITY |
| State: | IL |
| Postal Code: | 604097200 |
| Phone Number: | 7088988745 |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2012 |
| NPI Last Update Date: | 04/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.007091 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |