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General NPI Number Information
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NPI Number | 1346025103
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Entity Type | Individual
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Provider Name | DAKOTA CHASE STANLEY
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Gender | Male
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 309 VOLUNTEER AVE
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City | CLINTWOOD
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State | VA
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Zip | 24228-9400
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Country | US
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Telephone | 276-926-4644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1127
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City | CLINTWOOD
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State | VA
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Zip | 24228-1127
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Country | US
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Telephone | 276-926-4644
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 0813001253
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License Number State | VA
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