Southwest Virginia Child Development Services
Organization Active NPI Clinical Psychologist · Gate City, VA
NPI 1134477060 · NPPES record last updated Apr 12, 2013
Key facts
- NPI
- 1134477060
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2451 (VA)
- Legal business name
- SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES
- Practice address
- 142 W Jackson St
Suite 101
Gate City, VA 24251-2929 - Phone
- (276) 386-2535
- NPI assigned
- Aug 27, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Michael C McDonough, LCP
- Title
- Licensed Clinical Psychologist/Part
- Phone
- (276) 386-2534
Practitioners 1
-
Michael C McDonough, LICENSED CLINICALPSY
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130711000916 | VA | Part B Supplier - Clinic/Group Practice | 9234379454 |
Receives reassigned benefits from 1 practitioner Practice locations: Gate City, VA |
National Provider Directory
Locations
142 West Jackson St
#101
Gate City, VA 24251
Phone (276) 386-2534
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 2451 | VA | Yes |
| Clinical Social Worker |
1041C0700X | 0904004740 | VA |
Addresses
Primary practice location
142 W Jackson St
Suite 101
Gate City, VA 24251-2929
Mailing address
142 W Jackson St
Suite 101
Gate City, VA 24251-2929
Phone (276) 386-2535
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1469 | Other | VA | BUSINESS LICENSE NUMBER |
Other providers in Gate City, VA
- Betty Kimbler Smith
- Kellie Dorton Smith
- Lester Earl Smith Sr.
- Lester Earl Smith Jr.
- Roderick Malcolm Smith
- Southwest Virginia Child Development Services Corp
- Templeton Dentistry, PC
- Therapy Innovations Inc
- Kayla Brooke Tiller
- Karen Bryant Valk
All providers in Gate City, VA · Clinical Psychologist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.