Stacey Waller is a Clinical in Charleston, . Stacey Waller practices all healthcare services and medical treatments related to Clinical. The NPI Number for Stacey Waller is 1114990900. The last update date is 2008-06-04.
Stacey Waller's current location address is 1097 Fledderjohn Rd Ste 3, Charleston, . You can contact this provider via phone number 3043450880 and fax number 3043451112. The mailing address for Stacey Waller is 1097 Fledderjohn Rd Ste 3, Charleston, . To know further, please read the information below!
Provider Profile Detail
| Provider Name | Stacey Waller |
|---|---|
| Address | 1097 Fledderjohn Rd Ste 3, Charleston, |
| Phone Number | 3043450880 |
| Fax Number | 3043451112 |
| Sole Proprietor | N |
| Credentials | PH.D. |
NPI Number Detail
| NPI Number | 1114990900 |
|---|---|
| Provider Enumeration Date | 2006-02-10 |
| Last Updated Date | 2008-06-04 |
Provider Mailing Address Detail
| Address | 1097 Fledderjohn Rd Ste 3 |
|---|---|
| City | Charleston |
| State | (WV) |
| Post Code | 253144208 |
| Phone Number | 3043450880 |
| Fax Number | 3043451112 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 891 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3810001772 | WV | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Stacey Waller by the Centers for Medicare & Medicaid Services (CMS)?
The Stacey Waller has been assigned the NPI (National Provider Identifier) 1114990900. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
What is the area of specialization for Stacey Waller, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for Stacey Waller is Clinical, and the corresponding taxonomy code that categorizes this area of expertise is 103Tc0700X.
When was the Stacey Waller's 1114990900 issued?
The Stacey Waller's 1114990900 was issued on 2006-02-10.
On what date did the Centers for Medicare & Medicaid Services issue the 1114990900 to Stacey Waller?
The Stacey Waller received its 1114990900 assignment from the Centers for Medicare & Medicaid Services on 2006-02-10.
When was the information pertaining to Stacey Waller most recently updated or revised?
The details related to Stacey Waller, including its address, specialty, and other relevant information, were last updated or revised on 2008-06-04.