Organization
INDIVIDUALIZED COUNSELING PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA GAIL MISCO LCSW (PRESIDENT)
(540) 776-6466
Entity
Organization
Contact information
Practice address
3536 BRAMBLETON AVE, SUITE 1-B, ROANOKE, VA 24018-6526
(540) 776-6466
Mailing address
3536 BRAMBLETON AVE, SUITE 1-B, ROANOKE, VA 24018-6526
(540) 776-6466
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005798
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010089247
—
VA
01
—
145295
ANTHEM
VA
Enumeration date
10/20/2006
Last updated
03/17/2011
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