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NPI Code Detail

MEDICARE: MRS. CHARLENE THEPSIMUONG LCSW

MEDICARE:  MRS. CHARLENE  THEPSIMUONG  LCSW
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
11041C0700XClinical Social Worker0904009781VA

General Provider Information

NPI Number : 1306386727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARLENE THEPSIMUONG LCSW
Provider Business Mailing Address
First Line : 7211 CLOVERDALE RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-8221
Country : US
Telephone Number : 540-966-5808
Fax Number :
Provider Business Practice Location Address
First Line : 707 5TH ST NE
Second Line :
City : ROANOKE
State : VA
Zip : 24016-2123
Country : US
Telephone Number : 540-819-3622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2017
Last Update Date : 11/10/2020

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Directions to “ MRS. CHARLENE THEPSIMUONG LCSW” Practice Location

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