Provider Demographics
NPI:1730791443
Name:ROCHE, ROBIN HOTARD (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:HOTARD
Last Name:ROCHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CLANDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8839
Mailing Address - Country:US
Mailing Address - Phone:504-427-0197
Mailing Address - Fax:
Practice Address - Street 1:3209 CLANDON PARK DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-8839
Practice Address - Country:US
Practice Address - Phone:504-427-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0084381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical