| Southwest Virginia Child Development Services Corp | |
|
142 W Jackson St # 101 Gate City VA 24251-2929 | |
| (276) 386-2534 | |
| (276) 386-2535 |
| Full Name | Southwest Virginia Child Development Services Corp |
|---|---|
| Speciality | Psychologist |
| Location | 142 W Jackson St # 101, Gate City, Virginia |
| Authorized Official Name and Position | Micahel C Mcdonough (LICENSED CLINICAL PSYCHOLOGIST) |
| 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 Corp 142 W Jackson St # 101 Gate City VA 24251-2929 Ph: (276) 386-2534 | Southwest Virginia Child Development Services Corp 142 W Jackson St # 101 Gate City VA 24251-2929 Ph: (276) 386-2534 |
| NPI Number | 1982333167 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 08/29/2022 |
| Certification Date | 08/29/2022 |
| Medicare PECOS PAC ID | 9830578905 |
|---|---|
| Medicare Enrollment ID | O20220621000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982333167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Michael C Mcdonough |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1689960221 PECOS PAC ID: 0941469506 Enrollment ID: I20120913000444 |
Family Preservation Services, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 130 Grover Cleveland Ln, Gate City, VA 24251 Phone: 276-431-7214 Fax: 276-431-7215 | |
Southwest Virginia Child Development Services Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 142 W Jackson St, Suite 101, Gate City, VA 24251 Phone: 276-386-2535 | |
Family Preservation Services, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 135 Beech Street, Gate City, VA 24251 Phone: 276-431-7214 Fax: 276-431-7215 |