Provider Demographics
NPI:1477960409
Name:STOVALL, JOANN (LMSW, LCAC, CRAADC,)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:LMSW, LCAC, CRAADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E 63RD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-5338
Mailing Address - Country:US
Mailing Address - Phone:913-890-7553
Mailing Address - Fax:913-492-4284
Practice Address - Street 1:1211 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2129
Practice Address - Country:US
Practice Address - Phone:913-788-1285
Practice Address - Fax:913-492-4284
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS127101YA0400X
MO2014004990104100000X
KS8371104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)