Healthcare Provider Details

I. General information

NPI: 1003649823
Provider Name (Legal Business Name): STACY JANELL HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9039 W BROAD ST STE 1
HENRICO VA
23294-5842
US

IV. Provider business mailing address

9039 W BROAD ST STE 1
HENRICO VA
23294-5842
US

V. Phone/Fax

Practice location:
  • Phone: 804-728-0088
  • Fax:
Mailing address:
  • Phone: 214-531-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704017051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: