Provider Demographics
NPI:1275937591
Name:SALLIE M. ROSS, LCSW, PLC
Entity Type:Organization
Organization Name:SALLIE M. ROSS, LCSW, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-962-3027
Mailing Address - Street 1:1921 VIA FLORENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3557
Mailing Address - Country:US
Mailing Address - Phone:434-962-3027
Mailing Address - Fax:434-282-2135
Practice Address - Street 1:1405 ROLKIN CT
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3586
Practice Address - Country:US
Practice Address - Phone:434-962-3027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992913677OtherNPPES (INDIVIDUAL NPI)