Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | 0813000304 | VA |
Y | 103TS0200X | School Psychologist | PGP-186309 | VA |
NPI | 1063915106 |
---|---|
Provider Name | Cline Richard Munsey JR. |
First Address | Hillsville, VA 24343-1463 |
Second Address | Hillsville, VA 24343-1463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2018 |
Last Update Date | 15/03/2018 |