Organization
SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES CORP
Active
Organization
SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICAHEL C MCDONOUGH ED.D (LICENSED CLINICAL PSYCHOLOGIST)
(276) 386-2534
Entity
Organization
Contact information
Practice address
142 W JACKSON ST # 101, GATE CITY, VA 24251-2929
(276) 386-2534
(276) 386-2535
Mailing address
142 W JACKSON ST # 101, GATE CITY, VA 24251-2929
(276) 386-2534
(276) 386-2535
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
06/06/2022
Last updated
08/29/2022
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