MEDICARE: STACEY VANCE PRSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	22-978	WV

General Provider Information

NPI Number	:	1891423349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY VANCE PRSS

Provider Business Mailing Address
First Line	:	612 KANAWHA TER APT D
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-2942
Country	:	US
Telephone Number	:	304-373-6956
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 MACCORKLE AVE
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-2073
Country	:	US
Telephone Number	:	304-766-0060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	03/20/2025

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Directions to “ STACEY VANCE PRSS” Practice Location

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