Provider Demographics
NPI:1871920991
Name:APPALACHIAN COUNSELING SERVICES, INC
Entity type:Organization
Organization Name:APPALACHIAN COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC
Authorized Official - Phone:276-859-2129
Mailing Address - Street 1:1015A LOVER'S GAP RIAD
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24657
Mailing Address - Country:US
Mailing Address - Phone:276-859-2129
Mailing Address - Fax:
Practice Address - Street 1:1034 FREEHOLD ROAD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:VA
Practice Address - Zip Code:24239
Practice Address - Country:US
Practice Address - Phone:276-859-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004867261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)