MEDICARE: THREE VALLEY WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275398331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE VALLEY WELLNESS LLC

Provider Business Mailing Address
First Line	:	2302 COLONIAL AVE SW STE F
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3100
Country	:	US
Telephone Number	:	540-566-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 COLONIAL AVE SW STE F
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3100
Country	:	US
Telephone Number	:	540-566-9706
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	SHARON SUDOL
Credential	:	MA, LPC
Telephone Number	:	540-566-9706

Provider Enumeration Date	:	02/19/2024
Last Update Date	:	03/25/2025

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