Provider Demographics
NPI:1992817639
Name:ROEHRICH, SUSAN K (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:ROEHRICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 GRAVES MILL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2656
Mailing Address - Country:US
Mailing Address - Phone:434-385-8948
Mailing Address - Fax:434-385-5947
Practice Address - Street 1:2007 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2656
Practice Address - Country:US
Practice Address - Phone:434-385-8948
Practice Address - Fax:434-385-5947
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAANTHEM BLUE CROSSOther242636