Healthcare Provider Details

I. General information

NPI: 1568881605
Provider Name (Legal Business Name): JUDY VITA MACDONALD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CENTURY BLVD STE 220
NASHVILLE TN
37214-3787
US

IV. Provider business mailing address

2221 WILLOW OAK CIR APT 212
VIRGINIA BEACH VA
23451-6823
US

V. Phone/Fax

Practice location:
  • Phone: 844-295-4273
  • Fax: 855-611-1917
Mailing address:
  • Phone: 757-589-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903002319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: