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General NPI Number Information
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NPI Number | 1942370911
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Entity Type | Individual
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Provider Name | STACEY LYNN CRANDALL MS, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 100 CORPORATE DR
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City | MORGANTOWN
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State | WV
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Zip | 26501-4580
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Country | US
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Telephone | 304-241-1766
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Fax | 304-381-2648
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Provider Business Mailing Address
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Address Line | 648 ROCKLEY RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-2931
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Country | US
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Telephone | 304-777-8620
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P54457
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2072
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License Number State | WV
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