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General NPI Number Information
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NPI Number | 1639670946
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Entity Type | Individual
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Provider Name | RUSSELL ALAN BAYS II LPC
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Gender | Male
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1454 MEXICO WAY NE
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City | ROANOKE
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State | VA
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Zip | 24012-6476
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Country | US
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Telephone | 434-515-3529
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 MEXICO WAY NE
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City | ROANOKE
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State | VA
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Zip | 24012-6476
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Country | US
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Telephone | 434-515-3529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701007518
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License Number State | VA
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