Healthcare Provider Details

I. General information

NPI: 1376346056
Provider Name (Legal Business Name): CHAD MICHAEL STILES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 FAIRFAX BLVD STE 500
FAIRFAX VA
22030-5017
US

IV. Provider business mailing address

226 MONTREAL WAY
FALLING WATERS WV
25419-0200
US

V. Phone/Fax

Practice location:
  • Phone: 304-576-5792
  • Fax:
Mailing address:
  • Phone: 304-906-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0003103
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717002631
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMF.8383MFT
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: