Provider Demographics
NPI:1699006247
Name:WEST, JOHN MARK (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:WEST
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MARK
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:860 MOUNT VERNON LN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2700
Mailing Address - Country:US
Mailing Address - Phone:540-389-5468
Mailing Address - Fax:540-389-5570
Practice Address - Street 1:860 MOUNT VERNON LN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-2700
Practice Address - Country:US
Practice Address - Phone:540-389-5468
Practice Address - Fax:540-389-5570
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical