| Essential Life Therapies Inc | |
|
5507 Downing St Roanoke VA 24018-8704 | |
| (540) 989-0315 | |
| (540) 774-1292 |
| Full Name | Essential Life Therapies Inc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5507 Downing St, Roanoke, Virginia |
| Authorized Official Name and Position | Jackie C Claxton (PRESIDENT) |
| Authorized Official Contact | 5409890315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Essential Life Therapies Inc Po Box 4127 Roanoke VA 24015-0127 Ph: (540) 981-9394 | Essential Life Therapies Inc 5507 Downing St Roanoke VA 24018-8704 Ph: (540) 989-0315 |
| NPI Number | 1063592608 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 06/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063592608 | NPI | - | NPPES |
| 008925721 | Medicaid | VA | |
| 215418 | Other | VA | ANTHEM BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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