Provider Demographics
NPI:1104120294
Name:PIEDMONT PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:PIEDMONT PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-315-8813
Mailing Address - Street 1:200B MILNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2817
Mailing Address - Country:US
Mailing Address - Phone:434-315-8813
Mailing Address - Fax:434-315-5913
Practice Address - Street 1:200B MILNWOOD RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2817
Practice Address - Country:US
Practice Address - Phone:434-315-8813
Practice Address - Fax:434-315-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003954101YP2500X
VA0810001049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty