Provider Demographics
NPI:1639240401
Name:SLEDD, POARCH G (LPC)
Entity Type:Individual
Prefix:
First Name:POARCH
Middle Name:G
Last Name:SLEDD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 CYPRESS PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8440
Mailing Address - Country:US
Mailing Address - Phone:540-772-1872
Mailing Address - Fax:540-772-4830
Practice Address - Street 1:4220 CYPRESS PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8440
Practice Address - Country:US
Practice Address - Phone:540-772-1872
Practice Address - Fax:540-772-4830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health