Theodus Marques Roach, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C005319 Issued in NC

Practice address

210 Postage Way #1772
Indian Trail, NC 28079-9701

Phone

(980) 338-5563

Fax

(704) 228-0260

NPI assigned

Jul 18, 2006

Last updated

Feb 17, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC, SC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Clinical

  Medicare reassignment NPD
• Ethos Services

  • Community/Behavioral Health Agency
  • Gastonia, NC
  • NPI 1639806359

  Clinical

  Medicare reassignment NPD
• Monarch

  • Community/Behavioral Health Agency
  • Albemarle, NC
  • NPI 1801116405
  Medicare reassignment NPD
• Oasis Clinical Care Management & Consultation PLLC

  dba Oasis Clinical Care Management

  • Clinical Social Worker
  • Indian Trail, NC
  • NPI 1649391939
  NPD Authorized official
• Monarch

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1073267126
  NPD
• Monarch

  • Community/Behavioral Health Agency
  • Raleigh, NC
  • NPI 1588067367
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1154340768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 SEBASTIAN CT",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793688",
            "telephone_number": "980-338-5563",
            "fax_number": "800-853-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 POSTAGE WAY #1772",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280799701",
            "telephone_number": "980-338-5563",
            "fax_number": "704-228-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "THEODUS",
        "middle_name": "MARQUES",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "65730",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005319",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106359",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard M Holmes DMD, PA (Indian Trail Dental Associates)
• Danielle Tina Richardson, LCSW
• Marilyn Richardson
• Quincy Ridley, BSW, MSW, LCSWA
• Christina Zafiris Rigas, MS-CCC.SLP
• Betty J Robinson, LPC
• James Paul Robson Jr., N.P.
• Francy Johana Rodriguez, N.D., LAC
• Jasmine Lorraine Rosario, LMBT-MLD
• Diana Rowan, PHD, MSW, LCSW

• Clinical Social Worker in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.