Healthcare Provider Details

I. General information

NPI: 1508450180
Provider Name (Legal Business Name): NATALIE LINH LA
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: NAT LA

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 ELECTRIC RD STE 330
ROANOKE VA
24018-4563
US

IV. Provider business mailing address

3959 ELECTRIC RD STE 330
ROANOKE VA
24018-4563
US

V. Phone/Fax

Practice location:
  • Phone: 540-339-7674
  • Fax:
Mailing address:
  • Phone: 971-254-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: