| Individualized Counseling Plc | |
|
3536 Brambleton Ave Suite 1-b Roanoke VA 24018-6526 | |
| (540) 776-6466 | |
| Not Available |
| Full Name | Individualized Counseling Plc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3536 Brambleton Ave, Roanoke, Virginia |
| Authorized Official Name and Position | Teresa Gail Misco (PRESIDENT) |
| Authorized Official Contact | 5407766466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Individualized Counseling Plc 3536 Brambleton Ave Suite 1-b Roanoke VA 24018-6526 Ph: (540) 776-6466 | Individualized Counseling Plc 3536 Brambleton Ave Suite 1-b Roanoke VA 24018-6526 Ph: (540) 776-6466 |
| NPI Number | 1174605745 |
|---|---|
| Provider Enumeration Date | 10/20/2006 |
| Last Update Date | 03/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174605745 | NPI | - | NPPES |
| 010089247 | Medicaid | VA | |
| 145295 | Other | VA | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904005798 (Virginia) | Primary |
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