Provider Demographics
NPI:1275877029
Name:STAPLER, EUSTACE JOHN III (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:EUSTACE
Middle Name:JOHN
Last Name:STAPLER
Suffix:III
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4898
Mailing Address - Country:US
Mailing Address - Phone:703-435-7251
Mailing Address - Fax:703-435-7694
Practice Address - Street 1:487 CARLISLE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4898
Practice Address - Country:US
Practice Address - Phone:703-435-7251
Practice Address - Fax:703-435-7694
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-701005330OtherBOARD OF COUNSELING