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General NPI Number Information
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NPI Number | 1386920163
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Entity Type | Individual
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Provider Name | KRISTI STACKENS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 985 FLORENCE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-3484
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Country | US
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Telephone | 731-727-8012
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Fax | 731-727-8013
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Provider Business Mailing Address
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Address Line | 985 FLORENCE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-3484
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Country | US
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Telephone | 731-727-8012
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Fax | 731-727-8013
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | TN
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