Provider Demographics
NPI:1376519678
Name:WESTERVELT, JOHN I JR (LCSW LSATP SAP ADS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:WESTERVELT
Suffix:JR
Gender:M
Credentials:LCSW LSATP SAP ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 PENN FOREST PL
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5140
Mailing Address - Country:US
Mailing Address - Phone:540-981-7963
Mailing Address - Fax:540-344-0501
Practice Address - Street 1:2017 JEFFERSON ST SW
Practice Address - Street 2:CRMH REHABILITATION CENTER
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-981-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904-0033541041C0700X
VA0718000003101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008930490Medicaid
VA1376519678Medicaid
VA008953384Medicaid
VA010198569Medicaid
VA010198674Medicaid
VA8918309Medicaid
VA010198569Medicaid
VA008953384Medicaid
VA1376519678Medicaid
VA800001890Medicare PIN
VA00W552C23Medicare PIN
VA017303C19Medicare PIN