Individual
MRS. TABITHA BAGNALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S
Contact information
Practice address
750 IMPERIAL ST, CHRISTIANSBURG, VA 24073-5309
(540) 382-5100
Mailing address
40 DOUGLAS AVE NW, ROANOKE, VA 24012-4611
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0813000654
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0813000654
—
VA
Enumeration date
02/27/2018
Last updated
12/09/2019
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