Provider Demographics
NPI:1093007080
Name:STACEY, PAMELA (RN, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:STACEY
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 PATTERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-282-3387
Mailing Address - Fax:804-282-1724
Practice Address - Street 1:6720 PATTERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-288-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001127373163W00000X
VA0701002904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse