Provider Demographics
NPI:1083129126
Name:WELLSPRING COUNSELING GROUP
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:ROBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-312-9832
Mailing Address - Street 1:4800 PLEASANT HILL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3406
Mailing Address - Country:US
Mailing Address - Phone:540-777-3935
Mailing Address - Fax:
Practice Address - Street 1:4800 PLEASANT HILL DR STE 102
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3406
Practice Address - Country:US
Practice Address - Phone:540-777-3935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904010077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health