| Organization Name: | SOUTHWEST VIRGINIA CHILD DEVELOPMENT SERVICES |
| NPI Number: | 1134477060 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL C MCDONOUGH (LICENSED CLINICAL PSYCHOLOGIST/PART) |
| Mailing Address: | 142 W Jackson St Suite 101 Gate City |
| State: | VA US |
| Postal Code: | 242512929 |
| Phone Number: | 2763862535 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2012 |
| NPI Last Update Date: | 04/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0904004740 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |