Provider Demographics
NPI:1033522123
Name:STALB, KACIE ANN (BA)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:ANN
Last Name:STALB
Suffix:
Gender:F
Credentials:BA
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Mailing Address - Street 1:1440 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1236
Mailing Address - Country:US
Mailing Address - Phone:610-644-6464
Mailing Address - Fax:610-981-6078
Practice Address - Street 1:1725 OREGON PIKE
Practice Address - Street 2:SUITE 205B
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4206
Practice Address - Country:US
Practice Address - Phone:610-644-6464
Practice Address - Fax:610-981-6078
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)