Healthcare Provider Details

I. General information

NPI: 1932569316
Provider Name (Legal Business Name): ROANOKE VALLEY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 ELECTRIC RD STE 103
ROANOKE VA
24018-3500
US

IV. Provider business mailing address

2727 ELECTRIC RD STE 103
ROANOKE VA
24018-3500
US

V. Phone/Fax

Practice location:
  • Phone: 540-354-0911
  • Fax: 540-283-0769
Mailing address:
  • Phone: 540-354-0911
  • Fax: 540-283-0769

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS LEE HEASLEY
Title or Position: DIRECTOR
Credential: LPC, LMFT
Phone: 540-355-8578