Provider Demographics
NPI:1255203899
Name:ROSHON, ANNIE MARIE (LCDCIII161904)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIE
Last Name:ROSHON
Suffix:
Gender:F
Credentials:LCDCIII161904
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2411
Mailing Address - Country:US
Mailing Address - Phone:740-500-9089
Mailing Address - Fax:
Practice Address - Street 1:627 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2411
Practice Address - Country:US
Practice Address - Phone:740-500-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.1619-4101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)