Individual
FRED RICHARD MIGNONE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
159 WALTERS DR, CHRISTIANSBURG, VA 24073-1041
(540) 381-3101
(540) 381-3105
Mailing address
1715 GINGER LN, BLACKSBURG, VA 24060-2049
(540) 381-3101
(540) 381-3105
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005115
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008942455
—
VA
01
—
2116435
MAMSI
—
01
—
436723
ANTHEM
VA
01
—
455673000
MAGELLAN
—
01
—
515460
VALUE OPTIONS
—
01
—
7819434
AETNA
—
Enumeration date
02/03/2006
Last updated
04/10/2017
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