Healthcare Provider Details

I. General information

NPI: 1194708933
Provider Name (Legal Business Name): CARLA LEE BARNETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4346 STARKEY RD SUITE 1
ROANOKE VA
24018-0605
US

IV. Provider business mailing address

4346 STARKEY RD SUITE 1
ROANOKE VA
24018-0605
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8043
  • Fax: 540-772-8242
Mailing address:
  • Phone: 540-772-8043
  • Fax: 540-772-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0710101871
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: