Healthcare Provider Details

I. General information

NPI: 1831432335
Provider Name (Legal Business Name): JIM PRITCHARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
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 Number0701004114
License Number StateVA

VIII. Authorized Official

Name: MR. JAMES S PRITCHARD
Title or Position: OWNER
Credential: LPC
Phone: 540-521-8178