Provider Demographics
NPI:1063248862
Name:ROSZCZEWSKI, DAVID STANLEY (CADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STANLEY
Last Name:ROSZCZEWSKI
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 FRESH AIR DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2173
Mailing Address - Country:US
Mailing Address - Phone:810-542-3742
Mailing Address - Fax:
Practice Address - Street 1:H STREET
Practice Address - Street 2:BUILDING 326
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-451-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-26724101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)