Organization
SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES
Active
Organization
SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C MCDONOUGH LCP (LICENSED CLINICAL PSYCHOLOGIST/PART)
(276) 386-2534
Entity
Organization
Contact information
Practice address
142 W JACKSON ST, SUITE 101, GATE CITY, VA 24251-2929
(276) 386-2535
Mailing address
142 W JACKSON ST, SUITE 101, GATE CITY, VA 24251-2929
(276) 386-2535
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2451
VA
1041C0700X
Clinical Social Worker
0904004740
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1469
BUSINESS LICENSE NUMBER
VA
Enumeration date
08/27/2012
Last updated
04/12/2013
Update your record
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