Petrocci, Theo A

Petrocci, Theo A is an individual health care provider with primary practice located at 16 Walnut Ave Sw , Roanoke VA 24016-4719. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Petrocci, Theo A can be contacted via phone (540) 345-6468.

Contact Information

Primary practice address
16 Walnut Ave Sw Roanoke VA 24016-4719
Phone: (540) 345-6468
Fax: (540) 345-3204
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 0701000926 Virginia

Profile Details

NPI number 1922003458
LBN Legal business name Petrocci, Theo A
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 21st, 2005
Last updated Mar 29th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922003458 NPPES
Virginia MEDICAID 005401437

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