Provider Demographics
NPI:1144826777
Name:ROARK, JAMES BYRON III (LMHC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BYRON
Last Name:ROARK
Suffix:III
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 EAGLE BEND CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-1104
Mailing Address - Country:US
Mailing Address - Phone:813-758-1552
Mailing Address - Fax:
Practice Address - Street 1:1163 EAGLE BEND CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-1104
Practice Address - Country:US
Practice Address - Phone:813-758-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty