Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1155 | NC |
NPI | 1013061332 |
---|---|
Provider Name | Ms. Debra Lynn Roeschlein |
First Address | Clayton, NC 27520-3768 |
Second Address | Raleigh, NC 27607-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 02/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6111941 | (05) | NC |