Provider Demographics
NPI:1033673975
Name:ROTH, NYOMI S (LPC-S)
Entity type:Individual
Prefix:
First Name:NYOMI
Middle Name:S
Last Name:ROTH
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:NYOMI
Other - Middle Name:S
Other - Last Name:TARPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:2250 MURRELL RD STE B3
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2160
Mailing Address - Country:US
Mailing Address - Phone:434-515-2592
Mailing Address - Fax:
Practice Address - Street 1:2250 MURRELL RD STE B3
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2160
Practice Address - Country:US
Practice Address - Phone:434-515-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011321101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional