| Organization Name: | SW VA PSYCHOLOGICAL SERVICES |
| NPI Number: | 1063662229 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN WALLACE LUDGATE (PRESIDENT) |
| Mailing Address: | 361b Falls Dr Nw Abingdon |
| State: | VA US |
| Postal Code: | 242108093 |
| Phone Number: | 2766285752 |
| Fax Number: | 2766285190 |
| NPI Enumeration Date: | 09/24/2008 |
| NPI Last Update Date: | 09/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0810002165 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |