Basic Information
| Provider Information | |||||||||
| NPI: | 1013061332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROESCHLEIN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 NARCISSUS CT | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275203768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195502199 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2315 MYRON DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276073344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198658706 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 10/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1155 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 6111941 | 05 | NC | MEDICAID |