Provider Demographics
NPI:1306274691
Name:KALCHTHALER, CHRISTINE (CAGS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:KALCHTHALER
Suffix:
Gender:F
Credentials:CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15D LOUDOUN ST SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2908
Mailing Address - Country:US
Mailing Address - Phone:571-293-1123
Mailing Address - Fax:
Practice Address - Street 1:15D LOUDOUN ST SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2908
Practice Address - Country:US
Practice Address - Phone:571-293-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist