MEDICARE: POARCH G. SLEDD LPC

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	0701000679	VA

General Provider Information

NPI Number	:	1639240401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POARCH G. SLEDD LPC

Provider Business Mailing Address
First Line	:	4220 CYPRESS PARK DR
Second Line	:	SUITE B
City	:	ROANOKE
State	:	VA
Zip	:	24018-8440
Country	:	US
Telephone Number	:	540-772-1872
Fax Number	:	540-772-4830

Provider Business Practice Location Address
First Line	:	4220 CYPRESS PARK DR
Second Line	:	SUITE B
City	:	ROANOKE
State	:	VA
Zip	:	24018-8440
Country	:	US
Telephone Number	:	540-772-1872
Fax Number	:	540-772-4830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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