| Sw Va Psychological Services | |
|
361b Falls Dr Nw Abingdon VA 24210-8093 | |
| (276) 628-5752 | |
| (276) 628-5190 |
| Full Name | Sw Va Psychological Services |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 361b Falls Dr Nw, Abingdon, Virginia |
| Authorized Official Name and Position | John Wallace Ludgate (PRESIDENT) |
| Authorized Official Contact | 2766285752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sw Va Psychological Services Po Box 245 Abingdon VA 24212-0245 Ph: (276) 628-5752 | Sw Va Psychological Services 361b Falls Dr Nw Abingdon VA 24210-8093 Ph: (276) 628-5752 |
| NPI Number | 1063662229 |
|---|---|
| Provider Enumeration Date | 09/24/2008 |
| Last Update Date | 09/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063662229 | NPI | - | NPPES |
| 007703171 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0810002165 (Virginia) | Primary |
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