Provider Demographics
NPI:1114289717
Name:STALEY, AVRIL L (BA, QP, CSAC-INTERN)
Entity Type:Individual
Prefix:MISS
First Name:AVRIL
Middle Name:L
Last Name:STALEY
Suffix:
Gender:F
Credentials:BA, QP, CSAC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30373
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27130-0373
Mailing Address - Country:US
Mailing Address - Phone:336-784-9470
Mailing Address - Fax:
Practice Address - Street 1:3998 DALTON ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-3428
Practice Address - Country:US
Practice Address - Phone:336-784-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)