Individual
KRISTI GOWELL ROARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
10 ENDICOT STREET, WOLFEBORO, NH 03894
(603) 569-4776
Mailing address
PO BOX 255, WOLFEBORO, NH 03894-0255
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1355
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7706638Y0NH01
ANTHEM
—
Enumeration date
04/03/2007
Last updated
08/27/2018
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