Tara Sandrea Roach, MSW,LCSW LCAS,CCSOTS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CO13763 Issued in NC

Practice address

2428 Charles Blvd Ste 102
Greenville, NC 27858-6052

Phone

(919) 337-2644

Fax

(919) 882-9289

NPI assigned

May 23, 2016

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dominating Therapeutic Services, PLLC

  • Clinical Social Worker
  • Greenville, NC
  • NPI 1871276998
  Medicare reassignment Authorized official
• Priority Care Medical Services Inc.

  • Non-emergency Medical Transport (VAN)
  • Windsor, NC
  • NPI 1215060934
  NPD (past)

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1164879854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3883",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278361883",
            "telephone_number": "252-531-6226",
            "fax_number": "919-882-9289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 CHARLES BLVD STE 102",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278586052",
            "telephone_number": "919-337-2644",
            "fax_number": "919-882-9289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Lynndale Ct Ste F",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278585443",
            "country_code": "US",
            "telephone_number": "252-353-8001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "TARA",
        "middle_name": "SANDREA",
        "name_prefix": "Mrs.",
        "credential": "MSW,LCSW LCAS,CCSOTS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-23",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3168",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "CO13763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desirae Rivers, MSW, LCSWA
• Kaitlyn Marie Rizer, QBA
• Areeba Hussain Rizvi, MD
• Richard Phillip Rizzuti, MD
• Chelsea Ann Roach, MD
• Kevin A. Roark, CRNA
• Jeffrey W Robb, MD
• Adelaide Sarah Robbins, MD
• Almeta Roberson, LCSW-A
• Amelia Roberson

• Clinical Social Worker in Greenville, NC
• Providers in Greenville, 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 Nov 21, 2024; 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.