Healthcare Provider Details

I. General information

NPI: 1104880517
Provider Name (Legal Business Name): JANAN F HURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W MAIN ST
ABINGDON VA
24210-2608
US

IV. Provider business mailing address

460 W MAIN ST
ABINGDON VA
24210-2608
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-5752
  • Fax: 276-628-5190
Mailing address:
  • Phone: 276-628-5752
  • Fax: 276-628-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: