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General NPI Number Information
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NPI Number | 1528584331
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY THERAPY ASSOCIATES
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 5215 STARKEY RD
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City | ROANOKE
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State | VA
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Zip | 24018-9359
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Country | US
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Telephone | 540-293-9788
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Fax | 540-904-7731
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Provider Business Mailing Address
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Address Line | 4620 BUCK RUN DR APT D
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City | ROANOKE
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State | VA
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Zip | 24018-9042
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Country | US
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Telephone | 540-293-9788
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MITCHELL
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Credential | LCSW
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Telephone | 540-293-9788
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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 | 0904009910
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License Number State | VA
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