Waller, Stacey
Waller, Stacey is an individual health care provider with primary practice located at 1097 Fledderjohn Rd Ste 3 , Charleston WV 25314-4208. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Waller, Stacey can be contacted via phone (304) 345-0880.Contact Information
Primary practice address
1097 Fledderjohn Rd Ste 3
Charleston WV 25314-4208
Phone: (304) 345-0880
Fax: (304) 345-1112
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 891 | West Virginia |
Profile Details
| NPI number | 1114990900 |
|---|---|
| LBN Legal business name | Waller, Stacey |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 10th, 2006 |
| Last updated | Jun 4th, 2008 - about 18 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 | 1114990900 | NPPES |
| West Virginia | MEDICAID | 3810001772 |
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