=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154220937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRISH IQBAL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1356 ROANOKE RD
-----------------------------------------------------
City | DALEVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24083-2571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-591-7135
-----------------------------------------------------
Fax | 540-963-2000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 378 KOOGLER DR NW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24017-4626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701017129
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------