Healthcare Provider Details

I. General information

NPI: 1942135892
Provider Name (Legal Business Name): MICHAELA STAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 21ST ST STE 205
NORFOLK VA
23517-2130
US

IV. Provider business mailing address

1004 AZALEA CT APT B2
NORFOLK VA
23507-1149
US

V. Phone/Fax

Practice location:
  • Phone: 757-656-6461
  • Fax: 757-276-6741
Mailing address:
  • Phone: 276-608-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: