Healthcare Provider Details

I. General information

NPI: 1326269903
Provider Name (Legal Business Name): REBECCA L. STANLEY BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PAINTER STREET
GALAX VA
24333
US

IV. Provider business mailing address

112 PAINTER STREET
GALAX VA
24333
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-2994
  • Fax: 276-238-8762
Mailing address:
  • Phone: 276-236-2994
  • Fax: 276-238-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: