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General NPI Number Information
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NPI Number | 1306954557
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Entity Type | Individual
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Provider Name | VIRGINIA M STACK M.S.; L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 1121 WARREN AVE SUITE 260
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3570
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Country | US
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Telephone | 630-841-8705
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Fax | 630-820-5848
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Provider Business Mailing Address
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Address Line | 290 SHADY BROOK LN
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City | AURORA
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State | IL
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Zip | 60504-2043
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Country | US
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Telephone | 630-841-8705
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Fax | 630-820-5848
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180-003337
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License Number State | IL
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