Provider Demographics
NPI:1063924785
Name:APPALACHIAN THERAPY AND EVALUATION CORP
Entity type:Organization
Organization Name:APPALACHIAN THERAPY AND EVALUATION CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:BOWMAN
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-263-6158
Mailing Address - Street 1:PO BOX 1361
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1361
Mailing Address - Country:US
Mailing Address - Phone:828-278-9498
Mailing Address - Fax:
Practice Address - Street 1:249 WILSON DR STE 5
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8782
Practice Address - Country:US
Practice Address - Phone:828-278-9498
Practice Address - Fax:877-211-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2555103TC0700X
NCC0103751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND6107381Medicaid