Provider Demographics
NPI:1174669402
Name:STAVLAS, VICTORIA M (LPCC,LSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:M
Last Name:STAVLAS
Suffix:
Gender:F
Credentials:LPCC,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1872
Mailing Address - Country:US
Mailing Address - Phone:440-376-2844
Mailing Address - Fax:440-250-8864
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:440-376-2844
Practice Address - Fax:440-250-8864
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003190101YM0800X
OHS0006779104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid