Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000844 | VA |
NPI | 1023511425 |
---|---|
Provider Name | Megan Goard Vance |
First Address | Oak Hall, VA 23416-2114 |
Second Address | Oak Hall, VA 23416-2114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 12/03/2018 |