Healthcare Provider Details

I. General information

NPI: 1124955745
Provider Name (Legal Business Name): NEIGHBORLY SUPPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ANCHOR DR
ROANOKE VA
24012-1206
US

IV. Provider business mailing address

818 ANCHOR DR
ROANOKE VA
24012-1206
US

V. Phone/Fax

Practice location:
  • Phone: 540-819-8309
  • Fax:
Mailing address:
  • Phone: 540-819-8309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JERZIE NICOLE BOOSE
Title or Position: CLINICIAN
Credential: BS, CSAC-SUPERVISEE
Phone: 540-819-8309