Provider Demographics
NPI:1902274681
Name:SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
Entity Type:Organization
Organization Name:SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-783-1201
Mailing Address - Street 1:340 BAGLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-3126
Mailing Address - Country:US
Mailing Address - Phone:276-783-1200
Mailing Address - Fax:276-783-9712
Practice Address - Street 1:340 BAGLEY CIR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3126
Practice Address - Country:US
Practice Address - Phone:276-783-1200
Practice Address - Fax:276-783-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064821Medicaid