Provider Demographics
NPI:1053429357
Name:ROARK, ROBYN W (LPC)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:W
Last Name:ROARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 RAGAN RD
Mailing Address - Street 2:
Mailing Address - City:TRADE
Mailing Address - State:TN
Mailing Address - Zip Code:37691-6114
Mailing Address - Country:US
Mailing Address - Phone:423-727-4795
Mailing Address - Fax:
Practice Address - Street 1:132 POPLAR GROVE CONNECTOR #B
Practice Address - Street 2:SUITE 201
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-773-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001924101YP2500X
NC4346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional