Provider Demographics
NPI:1154354819
Name:GENARO, TINA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:JEAN
Last Name:GENARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 CYPRESS PARK DR STE F
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8417
Mailing Address - Country:US
Mailing Address - Phone:540-283-5215
Mailing Address - Fax:540-400-8177
Practice Address - Street 1:4212 CYPRESS PARK DR STE F
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8417
Practice Address - Country:US
Practice Address - Phone:540-283-5215
Practice Address - Fax:540-400-8177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003792101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010129800Medicaid