Healthcare Provider Details

I. General information

NPI: 1568537595
Provider Name (Legal Business Name): DEPAUL FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 HOLLINS RD
ROANOKE VA
24019-5056
US

IV. Provider business mailing address

5650 HOLLINS RD
ROANOKE VA
24019-5056
US

V. Phone/Fax

Practice location:
  • Phone: 540-265-8923
  • Fax: 540-206-1007
Mailing address:
  • Phone: 540-265-8923
  • Fax: 540-206-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberC00517
License Number StateVA

VIII. Authorized Official

Name: SUZANNE BENTLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, LCSW
Phone: 540-265-8923