Provider Demographics
NPI:1902802820
Name:DREVETS, ROMA G (PHD,LCPC,AAPS)
Entity Type:Individual
Prefix:DR
First Name:ROMA
Middle Name:G
Last Name:DREVETS
Suffix:
Gender:F
Credentials:PHD,LCPC,AAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2103
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-2103
Mailing Address - Country:US
Mailing Address - Phone:785-823-1961
Mailing Address - Fax:785-827-1401
Practice Address - Street 1:1700 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3401
Practice Address - Country:US
Practice Address - Phone:785-823-1961
Practice Address - Fax:785-827-1401
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS598101YA0400X
KSLCPC 179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119849OtherBLUE CROSS BLUE SHIELD KS