Healthcare Provider Details

I. General information

NPI: 1497766216
Provider Name (Legal Business Name): JAMES W HERRON LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/21/2009
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

3470 BRADSHAW RD
SALEM VA
24153-8712
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8043
  • Fax: 540-772-8242
Mailing address:
  • Phone: 540-384-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002200
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: