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General NPI Number Information
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NPI Number | 1265819874
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Entity Type | Organization
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Legal Business Name | MARTHA E MCCOY LCSW
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 509 PARK ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-4739
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Country | US
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Telephone | 434-218-0703
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Fax | 434-293-2310
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Provider Business Mailing Address
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Address Line | 509 PARK ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-4739
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Country | US
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Telephone | 434-218-0703
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Fax | 434-293-2310
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA E MCCOY
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Credential | LCSW
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Telephone | 434-218-0703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0904007133
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License Number State | VA
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