Provider Demographics
NPI:1487410726
Name:ROACH, YAMUNA CLEOPATRA (LCHMC)
Entity type:Individual
Prefix:MRS
First Name:YAMUNA
Middle Name:CLEOPATRA
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 APPLEMOOR CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7084
Mailing Address - Country:US
Mailing Address - Phone:336-470-7014
Mailing Address - Fax:
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD STE 306D
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9752
Practice Address - Country:US
Practice Address - Phone:336-497-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health