Healthcare Provider Details

I. General information

NPI: 1457397457
Provider Name (Legal Business Name): FAMILY SERVICE OF ROANOKE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CAMPBELL AVE SW
ROANOKE VA
24016-3625
US

IV. Provider business mailing address

360 CAMPBELL AVE SW
ROANOKE VA
24016-3625
US

V. Phone/Fax

Practice location:
  • Phone: 540-563-5316
  • Fax: 540-563-5254
Mailing address:
  • Phone: 540-563-5316
  • Fax: 540-563-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. LINDA HENTSCHEL
Title or Position: CEO
Credential:
Phone: 540-563-5316