Individual
MR. JOHN DAVID ROACH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2814 S US HIGHWAY 1 STE D4, FORT PIERCE, FL 34982-8110
(772) 489-4726
Mailing address
485 SE NOME DR, PORT SAINT LUCIE, FL 34984-8953
(772) 905-3374
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
03/18/2016
Last updated
03/18/2016
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