Provider Demographics
NPI:1558515601
Name:MINDA D. MCCABE, LCSW, BCD, PC
Entity Type:Organization
Organization Name:MINDA D. MCCABE, LCSW, BCD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDA
Authorized Official - Middle Name:DAMRON
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-665-1786
Mailing Address - Street 1:P.O. BOX 1444
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-665-1786
Mailing Address - Fax:540-722-4550
Practice Address - Street 1:4 W. MONMOUTH STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22604
Practice Address - Country:US
Practice Address - Phone:540-665-1786
Practice Address - Fax:540-722-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08739Medicare PIN