Provider Demographics
NPI:1508330242
Name:STAKELIN, CHASITI (LPCC)
Entity Type:Individual
Prefix:
First Name:CHASITI
Middle Name:
Last Name:STAKELIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 RING RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4431
Mailing Address - Country:US
Mailing Address - Phone:502-596-1389
Mailing Address - Fax:
Practice Address - Street 1:1690 RING RD STE 130
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4431
Practice Address - Country:US
Practice Address - Phone:502-596-1389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174456101Y00000X
KY274604101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor