Provider Demographics
NPI:1497766216
Name:HERRON, JAMES W (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:HERRON
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 BRADSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-8712
Mailing Address - Country:US
Mailing Address - Phone:540-384-6308
Mailing Address - Fax:
Practice Address - Street 1:4346 STARKEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0605
Practice Address - Country:US
Practice Address - Phone:540-772-8043
Practice Address - Fax:540-772-8242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002200101YP2500X
VA0717000037106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA240173OtherANTHEM BCBS
VA005400937Medicaid