Healthcare Provider Details

I. General information

NPI: 1659689883
Provider Name (Legal Business Name): GERALD SHOWALTER, PSY.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 OHIO ST STE M
WAYNESBORO VA
22980-2467
US

IV. Provider business mailing address

1009 LYNDHURST RD
WAYNESBORO VA
22980-5532
US

V. Phone/Fax

Practice location:
  • Phone: 540-447-0134
  • Fax: 540-941-1076
Mailing address:
  • Phone: 540-447-0134
  • Fax: 540-941-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810000262
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810000262
License Number StateVA

VIII. Authorized Official

Name: DR. GERALD R. SHOWALTER
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 540-447-0134