Healthcare Provider Details

I. General information

NPI: 1689373029
Provider Name (Legal Business Name): TAYLOR JO THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HOLLINS RD NE
ROANOKE VA
24012-7505
US

IV. Provider business mailing address

141 MIDKIFF RD SE
FLOYD VA
24091-3820
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-9200
  • Fax:
Mailing address:
  • Phone: 540-230-9667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: