Healthcare Provider Details

I. General information

NPI: 1881742427
Provider Name (Legal Business Name): APPALACHIAN CLINICAL ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 ELECTRIC RD SUITE 1-A
ROANOKE VA
24018-6448
US

IV. Provider business mailing address

3247 ELECTRIC RD SUITE 1-A
ROANOKE VA
24018-6448
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-0690
  • Fax: 540-772-0692
Mailing address:
  • Phone: 540-772-0690
  • Fax: 540-772-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001715
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001868
License Number StateVA

VIII. Authorized Official

Name: MICHAEL ANTHONY CHIGLINSKY
Title or Position: OWNER
Credential: PH.D.
Phone: 540-772-0690