Healthcare Provider Details

I. General information

NPI: 1851942734
Provider Name (Legal Business Name): KEITH HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BRAMBLETON AVE STE 201A
ROANOKE VA
24018-6527
US

IV. Provider business mailing address

1212 COMMONWEALTH CIR
FOREST VA
24551-2464
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-7550
  • Fax:
Mailing address:
  • Phone: 434-229-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008650
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: