Healthcare Provider Details

I. General information

NPI: 1952190894
Provider Name (Legal Business Name): SADIE MARVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 JAMISON AVE SE
ROANOKE VA
24013-2015
US

IV. Provider business mailing address

PO BOX 291943
NASHVILLE TN
37229-1943
US

V. Phone/Fax

Practice location:
  • Phone: 833-952-0829
  • Fax:
Mailing address:
  • Phone: 833-952-0829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: