Provider Demographics
NPI:1083799597
Name:SOUTHWESTERN VIRGINIA COUNSELING AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SOUTHWESTERN VIRGINIA COUNSELING AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-228-6900
Mailing Address - Street 1:1035 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2106
Mailing Address - Country:US
Mailing Address - Phone:276-228-6900
Mailing Address - Fax:276-228-6910
Practice Address - Street 1:1035 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2106
Practice Address - Country:US
Practice Address - Phone:276-228-6900
Practice Address - Fax:276-228-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA179565OtherANTHEM PROVIDER LEGACY
VA179557OtherANTHEM PROVIDER LEGACY
VA=========OtherTAX ID NUMBER
VAC09623Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
VA179565OtherANTHEM PROVIDER LEGACY
VA00W559S01Medicare ID - Type UnspecifiedPROVIDER LEGACY NUMBER