Provider Demographics
NPI:1538886700
Name:ROACH, ALAHNA M
Entity type:Individual
Prefix:
First Name:ALAHNA
Middle Name:M
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 WEBB DISTRICT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:ME
Mailing Address - Zip Code:04623-3330
Mailing Address - Country:US
Mailing Address - Phone:207-483-9681
Mailing Address - Fax:
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health