Provider Demographics
NPI:1568881605
Name:MACDONALD, JUDY VITA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:VITA
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 WILLOW OAK CIR APT 212
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6823
Mailing Address - Country:US
Mailing Address - Phone:757-589-7738
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3787
Practice Address - Country:US
Practice Address - Phone:844-295-4273
Practice Address - Fax:855-611-1917
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
VA0903002319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist