Provider Demographics
NPI:1427409655
Name:STUCKEY, ADELE (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 PENDLETON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2182
Mailing Address - Country:US
Mailing Address - Phone:703-596-9557
Mailing Address - Fax:
Practice Address - Street 1:1008 PENDLETON ST STE 1A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2182
Practice Address - Country:US
Practice Address - Phone:703-596-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 221700000X
VA0701007203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist