Organization
KATTRINA ROACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATTRINA MILLER ROACH PHD (OWNER)
(662) 404-1134
Entity
Organization
Contact information
Practice address
1622 MONTYS CIR, SOUTHAVEN, MS 38672-8547
(662) 404-1134
Mailing address
1622 MONTYS CIR, SOUTHAVEN, MS 38672-8547
(662) 404-1134
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2041
MS
Other
Enumeration date
11/19/2015
Last updated
11/19/2015
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