Healthcare Provider Details

I. General information

NPI: 1659345866
Provider Name (Legal Business Name): PATRICIA MARY CLOUGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 N MEDICAL PARK DR
FISHERSVILLE VA
22939-2344
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-2525
  • Fax: 540-213-2502
Mailing address:
  • Phone: 540-213-2525
  • Fax: 540-213-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001806
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: