51D2167647 CLIA NUMBER - APPALACHIAN WELLNESS CLINIC

Laboratory Demographics

CLIA Number: 51D2167647

Facility Name: APPALACHIAN WELLNESS CLINIC

Facility Address:
425 STANAFORD ROAD
BECKLEY, WV
ZIP 25801
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Facility Phone Number: 304 222-5817

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1427563238

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	51D2167647
LAB Type	Physician Office
Facility Name	APPALACHIAN WELLNESS CLINIC
Street	425 STANAFORD ROAD
City	BECKLEY
State	WV
ZIP	25801
Phone	304 222-5817
CertificateType	4
CertificateEffectiveDate	6/12/2023
CertificateExpirationDate	6/11/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024