MEDICARE: APPALACHIAN COUNSELING CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	0810001334	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	680001173	OTHER	VA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225339047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPALACHIAN COUNSELING CENTER PC

Provider Business Mailing Address
First Line	:	4330 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3419
Country	:	US
Telephone Number	:	540-774-4211
Fax Number	:	540-989-8793

Provider Business Practice Location Address
First Line	:	4330 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3419
Country	:	US
Telephone Number	:	540-774-4211
Fax Number	:	540-989-8793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN M KATZ
Credential	:	PH.D
Telephone Number	:	540-774-4211

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	01/03/2011

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