Provider Demographics
NPI:1508857699
Name:ROGER A. KALTHOFF, PH.D., P.A.
Entity Type:Organization
Organization Name:ROGER A. KALTHOFF, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KALTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-577-8041
Mailing Address - Street 1:711 S MARSHALL ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5849
Mailing Address - Country:US
Mailing Address - Phone:336-577-8041
Mailing Address - Fax:
Practice Address - Street 1:936 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2564
Practice Address - Country:US
Practice Address - Phone:336-577-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty