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General NPI Number Information
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NPI Number | 1104120294
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Entity Type | Organization
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Legal Business Name | PIEDMONT PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 200B MILNWOOD RD
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City | FARMVILLE
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State | VA
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Zip | 23901-2817
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Country | US
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Telephone | 434-315-8813
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Fax | 434-315-5913
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Provider Business Mailing Address
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Address Line | 200B MILNWOOD RD
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City | FARMVILLE
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State | VA
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Zip | 23901-2817
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Country | US
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Telephone | 434-315-8813
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Fax | 434-315-5913
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | MR. LYNN CARSON BLACKWOOD JR.
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Credential | PH.D.
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Telephone | 434-315-8813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003954
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001049
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License Number State | VA
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