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NPI Code Detail

MEDICARE: MRS. STACEY DAMKOHLER LPC

MEDICARE: MRS. STACEY DAMKOHLER LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor21307NC
2101YP2500XProfessional Counselor37PC01138700NJ

General Provider Information

NPI Number : 1265140370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACEY DAMKOHLER LPC
Provider Business Mailing Address
First Line : 315 KENT LN
Second Line :
City : KENTS STORE
State : VA
Zip : 23084-2269
Country : US
Telephone Number : 609-969-3009
Fax Number :
Provider Business Practice Location Address
First Line : 343 OLD GEORGES RD STE 201
Second Line :
City : NORTH BRUNSWICK
State : NJ
Zip : 08902-4801
Country : US
Telephone Number : 609-969-3009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2022
Last Update Date : 06/12/2025

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