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General NPI Number Information
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NPI Number | 1396086153
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Entity Type | Organization
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Legal Business Name | TRANSFORMED LEADERSHIP, LLC
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD SUITE 350
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City | ROANOKE
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State | VA
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Zip | 24018-4562
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Country | US
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Telephone | 540-685-2582
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Fax | 540-685-2583
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Provider Business Mailing Address
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Address Line | 3959 ELECTRIC RD SUITE 350
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City | ROANOKE
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State | VA
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Zip | 24018-4562
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Country | US
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Telephone | 540-685-2582
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Fax | 540-685-2583
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Authorized Official
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Title or Position | CEO
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Name | MS. SUSAN LAWYER WILLIS
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Credential |
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Telephone | 540-330-7228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | VA
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