Healthcare Provider Details

I. General information

NPI: 1639154578
Provider Name (Legal Business Name): NEW RIVER VALLEY COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E MAIN ST
PULASKI VA
24301-5218
US

IV. Provider business mailing address

1006 E MAIN ST
PULASKI VA
24301-5218
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-5023
  • Fax: 540-994-5028
Mailing address:
  • Phone: 540-994-5023
  • Fax: 540-994-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005646
License Number StateVA

VIII. Authorized Official

Name: MS. SHARON WOOD
Title or Position: DIRECTOR OF CHILD AND FAMILY SERVIC
Credential: M.S.
Phone: 540-961-8300