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General NPI Number Information
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NPI Number | 1124955745
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Entity Type | Organization
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Legal Business Name | NEIGHBORLY SUPPPORT LLC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 818 ANCHOR DR
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City | ROANOKE
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State | VA
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Zip | 24012-1206
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Country | US
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Telephone | 540-819-8309
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Fax |
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Provider Business Mailing Address
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Address Line | 818 ANCHOR DR
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City | ROANOKE
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State | VA
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Zip | 24012-1206
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Country | US
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Telephone | 540-819-8309
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | JERZIE NICOLE BOOSE
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Credential | BS, CSAC-SUPERVISEE
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Telephone | 540-819-8309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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