Dunielle Theresa Roman, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5573 Issued in NC

Practice address

1250 Western Blvd
Jacksonville, NC 28546-6748

Phone

(910) 378-9211

NPI assigned

Sep 5, 2014

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

Other names 1

• Theresa Roman Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Balanced Wellness, LLC

  • Clinical Psychologist
  • Bluffton, SC
  • NPI 1174276513
  NPD Authorized official

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624665600000",
    "number": "1639570922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466748",
            "telephone_number": "910-378-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 WESTERN BLVD",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466748",
            "telephone_number": "910-378-9211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Ahoy Dr",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299104307",
            "country_code": "US",
            "telephone_number": "910-378-9211",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Ahoy Dr",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299104307",
            "country_code": "US",
            "telephone_number": "910-378-9211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "DUNIELLE",
        "middle_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-05",
        "last_updated": "2021-06-26",
        "certification_date": "2021-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "5573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "ROMAN",
            "credential": "PSYD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jane Louise Rogers, RN, NP-OGNP
• Jennifer Lynn Rogers, PHARMD
• Louis C. Rogers Sr., LCSW-A
• Terra M Rohn, IBCLC,CLC
• Thomas Joseph Rojy Jr., MD
• John M Romulus, DDS
• Jose Larrabaster Ros, M.D
• Sonya Rosales
• Wilmina Beaumont Rosario, PH.D; LPC-S;LCAS;CCS
• Kylene Marie Rose

• Clinical Psychologist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.