Healthcare Provider Details

I. General information

NPI: 1043274475
Provider Name (Legal Business Name): SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BAGLEY CIRCLE
MARION VA
24354-3102
US

IV. Provider business mailing address

340 BAGLEY CIRCLE
MARION VA
24354-3102
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-1200
  • Fax: 276-783-1242
Mailing address:
  • Phone: 276-783-1200
  • Fax: 276-783-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA L. MCCLASKEY
Title or Position: DIRECTOR
Credential: PH.D
Phone: 276-783-1201