Provider Demographics
NPI:1548693633
Name:ROTHROCK, CHRISTAL ANN (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:ANN
Last Name:ROTHROCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:ANN
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBT-LBC
Mailing Address - Street 1:3225 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9380
Mailing Address - Country:US
Mailing Address - Phone:719-275-2351
Mailing Address - Fax:541-322-7565
Practice Address - Street 1:3225 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9380
Practice Address - Country:US
Practice Address - Phone:719-275-2351
Practice Address - Fax:541-322-7565
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-R-32101YA0400X
ORC3501101YP2500X
COLPC.0014414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)