Individual
JENNIFER ROARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
RTE 19 - 460, CEDAR BLUFF, VA 24609
(276) 964-6702
(276) 964-5669
Mailing address
PO BOX 810, CEDAR BLUFF, VA 24609
(276) 964-6702
(276) 964-5669
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003885
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192250
ANTHEM
VA
Enumeration date
06/09/2006
Last updated
07/08/2007
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