Individual
MRS. GWYNN JOHNSON POLIDORO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
200 8TH ST, RADFORD, VA 24141-2426
(540) 731-0838
(540) 731-3375
Mailing address
200 8TH ST, RADFORD, VA 24141-2426
(540) 731-0838
(540) 731-3375
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001071
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8906203
—
VA
Enumeration date
03/22/2006
Last updated
07/08/2007
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