MEDICARE: BABBLING BROOK COUNSELING SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407529779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABBLING BROOK COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	1140 BRAMLETT RD
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-6246
Country	:	US
Telephone Number	:	540-525-0908
Fax Number	:	540-215-7226

Provider Business Practice Location Address
First Line	:	302 WASHINGTON AVE SW STE B
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4312
Country	:	US
Telephone Number	:	540-524-9918
Fax Number	:	540-215-7226

Authorized Official
Title or Position	:	OWNER
Name	:	BROOKE ALSTON JERNIGAN
Credential	:	LCSW
Telephone Number	:	540-524-9918

Provider Enumeration Date	:	07/31/2021
Last Update Date	:	10/23/2021

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