Healthcare Provider Details

I. General information

NPI: 1821622549
Provider Name (Legal Business Name): DAVID CHALUPA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEXINGTON AVE STE 125
ASHLAND KY
41101-2800
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-7800
  • Fax: 606-408-6800
Mailing address:
  • Phone: 606-408-9571
  • Fax: 606-408-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number254360
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: