Chilstrom, Glen Allen
Chilstrom, Glen Allen is an sole proprietor health care provider with primary practice located at 109 S Fairfax St , Alexandria VA 22314-3301. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Chilstrom, Glen Allen can be contacted via phone (703) 765-6085.Contact Information
Primary practice address
109 S Fairfax St
Alexandria VA 22314-3301
Phone: (703) 765-6085
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0810001353 | Virginia |
Profile Details
| NPI number | 1326027293 |
|---|---|
| LBN Legal business name | Chilstrom, Glen Allen |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 10th, 2006 |
| Last updated | Feb 7th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326027293 | NPPES |
| Virginia | MEDICAID | 7701691 |
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