Healthcare Provider Details

I. General information

NPI: 1063432995
Provider Name (Legal Business Name): DEPAUL COMMUNITY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number02305001
License Number StateVA

VIII. Authorized Official

Name: RENEE BROWN
Title or Position: CEO
Credential: LPC, CSAC
Phone: 540-265-8923