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General NPI Number Information
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NPI Number | 1063078855
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Entity Type | Organization
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Legal Business Name | SOUTHWEST REGIONAL COUNSELING SERVICE INC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 1114 E MAIN ST STE 4
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City | LEBANON
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State | VA
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Zip | 24266-5014
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Country | US
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Telephone | 276-883-5050
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Fax | 276-883-5998
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | LEBANON
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State | VA
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Zip | 24266-0306
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Country | US
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Telephone | 273-883-5050
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Fax | 276-883-5998
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOSHUA LIPFORD
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Credential |
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Telephone | 423-895-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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