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General NPI Number Information
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NPI Number | 1194736991
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Entity Type | Organization
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Legal Business Name | DALLAS VA MEDICAL CENTER
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 521 JUDY LN
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City | SEAGOVILLE
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State | TX
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Zip | 75159-1713
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Country | US
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Telephone | 972-287-9162
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER II
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Name | MS. VASHAWN KIANGA CLEMONS
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Credential | LMSW
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Telephone | 214-857-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 31123
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License Number State | TX
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