Healthcare Provider Details

I. General information

NPI: 1699009613
Provider Name (Legal Business Name): RUTH WITTERSGREEN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 N AUGUSTA ST
STAUNTON VA
24401-3211
US

IV. Provider business mailing address

202 HENDREN AVE
STAUNTON VA
24401-2847
US

V. Phone/Fax

Practice location:
  • Phone: 540-887-6538
  • Fax: 202-333-2525
Mailing address:
  • Phone: 540-887-6538
  • Fax: 202-333-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003439
License Number StateVA

VIII. Authorized Official

Name: RUTH WITTERSGREEN
Title or Position: OWNER
Credential: PHD
Phone: 540-887-6538