Healthcare Provider Details

I. General information

NPI: 1720880206
Provider Name (Legal Business Name): ASHLEY STALNAKER PACK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY PACK PSYD

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 DONOHOE DR
HUNTINGTON WV
25705-8887
US

IV. Provider business mailing address

2561 COLLIS AVE
HUNTINGTON WV
25703-1636
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-3310
  • Fax:
Mailing address:
  • Phone: 304-389-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number1372
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: