Healthcare Provider Details

I. General information

NPI: 1932540259
Provider Name (Legal Business Name): DUGAN PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JUNKIN PL
LEXINGTON VA
24450-1822
US

IV. Provider business mailing address

6 JUNKIN PL
LEXINGTON VA
24450-1822
US

V. Phone/Fax

Practice location:
  • Phone: 512-567-6358
  • Fax: 737-263-1106
Mailing address:
  • Phone: 512-567-6358
  • Fax: 737-263-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64553
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number40671
License Number StateTX

VIII. Authorized Official

Name: JESSICA RUSH DUGAN
Title or Position: CO-OWNER
Credential:
Phone: 512-567-6358