Healthcare Provider Details

I. General information

NPI: 1346703956
Provider Name (Legal Business Name): MENTAL HEALTH AMERICA OF THE ROANOKE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHURCH AVE SE STE 300
ROANOKE VA
24011-2120
US

IV. Provider business mailing address

10 CHURCH AVE SE STE 300
ROANOKE VA
24011-2120
US

V. Phone/Fax

Practice location:
  • Phone: 540-344-0931
  • Fax: 540-344-0932
Mailing address:
  • Phone: 540-344-0931
  • Fax: 540-344-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANNIE HARVEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-344-0931