Organization
SOUTHWEST REGIONAL COUNSELING SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSHUA LIPFORD (MANAGER)
(423) 895-8266
Entity
Organization
Contact information
Practice address
1114 E MAIN ST STE 4, LEBANON, VA 24266-5014
(276) 883-5050
(276) 883-5998
Mailing address
PO BOX 306, LEBANON, VA 24266-0306
(273) 883-5050
(276) 883-5998
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528039054
—
VA
05
—
1720016389
—
VA
Enumeration date
05/16/2019
Last updated
05/16/2019
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