Provider Demographics
NPI:1194862813
Name:CHAPMAN-GOREY, STACIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:L
Last Name:CHAPMAN-GOREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5799
Mailing Address - Country:US
Mailing Address - Phone:757-345-6428
Mailing Address - Fax:
Practice Address - Street 1:215 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5799
Practice Address - Country:US
Practice Address - Phone:757-345-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC103121041C0700X
MELC121821041C0700X
VA09040094491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432466499Medicaid
ME432466499Medicaid