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Individual

MR. DERICK DANVIL ROACHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN LCSW PSYD

Contact information

Practice address
1201 FIRST STREET SOUTH, WINTER HAVEN, FL 33880
(863) 297-1702
(863) 291-6084
Mailing address
200 AVENUE F NORTH EAST, WINTER HAVEN, FL 33881
(863) 293-1121
(863) 291-6084

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN9178432
FL

Other

Enumeration date
10/17/2006
Last updated
07/08/2007
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