Provider Demographics
NPI:1477575058
Name:PIEDMONT-COFFEE, STACEY MEREDITH
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MEREDITH
Last Name:PIEDMONT-COFFEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:MEREDITH
Other - Last Name:PIEDMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2214 SPRINGWOOD DR
Mailing Address - Street 2:UNIT 103
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2350
Mailing Address - Country:US
Mailing Address - Phone:703-476-7867
Mailing Address - Fax:
Practice Address - Street 1:11975 BOWMAN TOWNE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3306
Practice Address - Country:US
Practice Address - Phone:703-481-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health