Healthcare Provider Details

I. General information

NPI: 1225339047
Provider Name (Legal Business Name): APPALACHIAN COUNSELING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 OLD CAVE SPRING RD
ROANOKE VA
24018-3419
US

IV. Provider business mailing address

4330 OLD CAVE SPRING RD
ROANOKE VA
24018-3419
US

V. Phone/Fax

Practice location:
  • Phone: 540-774-4211
  • Fax: 540-989-8793
Mailing address:
  • Phone: 540-774-4211
  • Fax: 540-989-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810001334
License Number StateVA

VIII. Authorized Official

Name: DR. ALAN M KATZ
Title or Position: PRESIDENT
Credential: PH.D
Phone: 540-774-4211