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General NPI Number Information
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NPI Number | 1174605745
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Entity Type | Organization
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Legal Business Name | INDIVIDUALIZED COUNSELING PLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 3536 BRAMBLETON AVE SUITE 1-B
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City | ROANOKE
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State | VA
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Zip | 24018-6526
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Country | US
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Telephone | 540-776-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 3536 BRAMBLETON AVE SUITE 1-B
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City | ROANOKE
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State | VA
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Zip | 24018-6526
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Country | US
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Telephone | 540-776-6466
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TERESA GAIL MISCO
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Credential | LCSW
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Telephone | 540-776-6466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904005798
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License Number State | VA
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