=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982815320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TESSIE SMITH SADLER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 E ATLANTIC ST
-----------------------------------------------------
City | SOUTH HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23970-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-774-7559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 301
-----------------------------------------------------
City | SOUTH HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23970-0301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-774-7559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER EMP
-----------------------------------------------------
Name | MS. TESSIE S. SADLER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 434-774-7559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904006071
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------