Healthcare Provider Details

I. General information

NPI: 1851258370
Provider Name (Legal Business Name): STEPHANIE ANN HALE RCPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 SOUTHERN DR
RUSTBURG VA
24588-3366
US

IV. Provider business mailing address

177 SOUTHERN DR
RUSTBURG VA
24588-3366
US

V. Phone/Fax

Practice location:
  • Phone: 434-907-1559
  • Fax:
Mailing address:
  • Phone: 434-907-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0735001430
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: