# ESSENTIAL LIFE THERAPIES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063592608
- **Authorized official:** MS. JACKIE C CLAXTON LCSW (PRESIDENT)
- **Authorized official phone:** (540) 989-0315

## Contact information

- **Practice address:** 5507 DOWNING ST, ROANOKE, VA 24018-8704
- **Practice address phone:** (540) 989-0315
- **Practice address fax:** (540) 774-1292
- **Mailing address:** PO BOX 4127, ROANOKE, VA 24015-0127
- **Mailing address phone:** (540) 981-9394
- **Mailing address fax:** (540) 344-7154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 06/23/2010