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General NPI Number Information
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NPI Number | 1265055321
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Entity Type | Organization
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Legal Business Name | INNER WISDOM YOGA AND PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 05/24/2020
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Last Update Date | 05/24/2020
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Provider Practice Location Address
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Address Line | 1420 3RD ST SW
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City | ROANOKE
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State | VA
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Zip | 24016-5205
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Country | US
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Telephone | 540-798-8478
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Fax |
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Provider Business Mailing Address
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Address Line | 2921 OAK CREST AVE SW
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City | ROANOKE
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State | VA
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Zip | 24015-4609
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Country | US
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Telephone | 540-798-8478
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNEMARIE CARROLL
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Credential | PHD
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Telephone | 540-798-8478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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