Healthcare Provider Details

I. General information

NPI: 1417304700
Provider Name (Legal Business Name): SWS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 BRAMBLETON AVE STE 5
ROANOKE VA
24018-6528
US

IV. Provider business mailing address

3524 BRAMBLETON AVE STE 5
ROANOKE VA
24018-6528
US

V. Phone/Fax

Practice location:
  • Phone: 540-314-9266
  • Fax:
Mailing address:
  • Phone: 540-314-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004190
License Number StateVA

VIII. Authorized Official

Name: MRS. SONDRA WILLIS STEPHENS
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 540-314-9266