Provider Demographics
NPI:1558762450
Name:APPALACHIAN FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:APPALACHIAN FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:740-591-3000
Mailing Address - Street 1:1838 LOVELY LN
Mailing Address - Street 2:
Mailing Address - City:LETART
Mailing Address - State:WV
Mailing Address - Zip Code:25253-9693
Mailing Address - Country:US
Mailing Address - Phone:740-591-3000
Mailing Address - Fax:
Practice Address - Street 1:503 2ND AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1218
Practice Address - Country:US
Practice Address - Phone:740-591-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6843103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty