Doctor Name: | DR. DOUGLAS KEITH ROACH |
NPI Number: | 1811178940 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH. D. |
License Number: | MH0003450 |
Business Practice Address: | 195 Hunt St Dresden, TN - 382251851 |
Business Phone Number: | 7313643739 |
Business Fax Number: | |
Mailing Address: | 195 Hunt St, DRESDEN |
State: | TN |
Postal Code: | 382251851 |
Phone Number: | 7313643739 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2007 |
NPI Last Update Date: | 11/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH0003450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |