Individual
MR. THEO A PETROCCI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
16 WALNUT AVE SW, ROANOKE, VA 24016-4719
(540) 345-6468
(540) 345-3204
Mailing address
3500 GROVE AVE, STE 102, RICHMOND, VA 23221-2220
(804) 822-0271
(804) 353-3939
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701000926
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005401437
—
VA
Enumeration date
06/21/2005
Last updated
03/29/2016
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