Provider Demographics
NPI:1487109203
Name:PAWLAK, ROGER JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:PAWLAK
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 ORCHARD HILL ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7996
Mailing Address - Country:US
Mailing Address - Phone:386-837-2472
Mailing Address - Fax:
Practice Address - Street 1:303 ORCHARD HILL ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7996
Practice Address - Country:US
Practice Address - Phone:386-837-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health