Healthcare Provider Details

I. General information

NPI: 1134659519
Provider Name (Legal Business Name): STACEY WHITT CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MAIN ST
MOREHEAD KY
40351-1671
US

IV. Provider business mailing address

104 S FRONT AVE
PRESTONSBURG KY
41653-1614
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-4161
  • Fax:
Mailing address:
  • Phone: 606-886-8572
  • Fax: 606-886-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7254
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: