Provider Demographics
NPI:1548911514
Name:ROCHA, IVANISE B
Entity type:Individual
Prefix:
First Name:IVANISE
Middle Name:B
Last Name:ROCHA
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 1:500 PEGASUS CT
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER VA
Mailing Address - State:VA
Mailing Address - Zip Code:22602
Mailing Address - Country:US
Mailing Address - Phone:540-313-4196
Mailing Address - Fax:540-686-7906
Practice Address - Street 1:500 PEGASUS CT.
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602
Practice Address - Country:US
Practice Address - Phone:540-313-4196
Practice Address - Fax:540-686-7906
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)