Provider Demographics
NPI:1407642218
Name:ROSEBOROUGH, APRIL L
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:L
Last Name:ROSEBOROUGH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 CONWAY CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4413
Mailing Address - Country:US
Mailing Address - Phone:786-295-3463
Mailing Address - Fax:786-295-3463
Practice Address - Street 1:2704 N OAK ST BLDG A1
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5901
Practice Address - Country:US
Practice Address - Phone:229-474-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25-429-243106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician