Organization
ESSENTIAL LIFE THERAPIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE C CLAXTON LCSW (PRESIDENT)
(540) 989-0315
Entity
Organization
Contact information
Practice address
5507 DOWNING ST, ROANOKE, VA 24018-8704
(540) 989-0315
(540) 774-1292
Mailing address
PO BOX 4127, ROANOKE, VA 24015-0127
(540) 981-9394
(540) 344-7154
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008925721
—
VA
01
—
215418
ANTHEM BCBS
VA
Enumeration date
10/17/2006
Last updated
06/23/2010
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