Healthcare Provider Details

I. General information

NPI: 1366264749
Provider Name (Legal Business Name): JANELLE NICOLE STATON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL DR
HAMPTON VA
23666-1769
US

IV. Provider business mailing address

4918 FALCON NEST PL APT 102
HAMPTON VA
23666-0907
US

V. Phone/Fax

Practice location:
  • Phone: 757-788-0600
  • Fax:
Mailing address:
  • Phone: 757-773-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014025
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: