| Southwest Virginia Child Development Services | |
|
142 W Jackson St Suite 101 Gate City VA 24251-2929 | |
| (276) 386-2535 | |
| Not Available |
| Full Name | Southwest Virginia Child Development Services |
|---|---|
| Speciality | Psychologist |
| Location | 142 W Jackson St, Gate City, Virginia |
| Authorized Official Name and Position | Michael C Mcdonough (LICENSED CLINICAL PSYCHOLOGIST/PART) |
| Authorized Official Contact | 2763862534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Virginia Child Development Services 142 W Jackson St Suite 101 Gate City VA 24251-2929 Ph: (276) 386-2535 | Southwest Virginia Child Development Services 142 W Jackson St Suite 101 Gate City VA 24251-2929 Ph: (276) 386-2535 |
| NPI Number | 1134477060 |
|---|---|
| Provider Enumeration Date | 08/27/2012 |
| Last Update Date | 04/12/2013 |
| Medicare PECOS PAC ID | 9234379454 |
|---|---|
| Medicare Enrollment ID | O20130711000916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134477060 | NPI | - | NPPES |
| 1469 | Other | VA | BUSINESS LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2451 (Virginia) | Primary |
| 1041C0700X | Social Worker - Clinical | 0904004740 (Virginia) | Secondary |
| Provider Name | Michael C Mcdonough |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1689960221 PECOS PAC ID: 0941469506 Enrollment ID: I20120913000444 |
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Family Preservation Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 248 E Jackson St, Gate City, VA 24251 Phone: 276-431-7214 Fax: 276-431-7215 |