Provider Demographics
NPI:1104071505
Name:COUNSELING ASSOCIATES OF SOUTHWEST VIRGINIA, INC.
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF SOUTHWEST VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES-FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:540-552-1402
Mailing Address - Street 1:200 PROFESSIONAL PARK DR SE STE 1
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6663
Mailing Address - Country:US
Mailing Address - Phone:540-552-1402
Mailing Address - Fax:540-552-3428
Practice Address - Street 1:200 PROFESSIONAL PARK DR SE STE 1
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6663
Practice Address - Country:US
Practice Address - Phone:540-552-1402
Practice Address - Fax:540-552-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty