Healthcare Provider Details

I. General information

NPI: 1376519678
Provider Name (Legal Business Name): JOHN I WESTERVELT JR. LCSW LSATP SAP ADS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 JEFFERSON ST SW CRMH REHABILITATION CENTER
ROANOKE VA
24014-2419
US

IV. Provider business mailing address

5830 PENN FOREST PL
ROANOKE VA
24018-5140
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7963
  • Fax:
Mailing address:
  • Phone: 540-981-7963
  • Fax: 540-344-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000003
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904-003354
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: