Provider Demographics
NPI:1871684902
Name:SPROUSE, JANET SUSAN (LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SUSAN
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:SUSAN
Other - Last Name:SUDDATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC;CSAC
Mailing Address - Street 1:2694 SUMMIT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6933
Mailing Address - Country:US
Mailing Address - Phone:540-977-1286
Mailing Address - Fax:
Practice Address - Street 1:1301 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017
Practice Address - Country:US
Practice Address - Phone:540-904-6799
Practice Address - Fax:540-904-6369
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional