Provider Demographics
NPI:1518558584
Name:REINHARDT, STACIA (MA, ATR, LPC)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:MA, ATR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 GROVE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3741
Mailing Address - Country:US
Mailing Address - Phone:484-560-7951
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMONWEALTH DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1894
Practice Address - Country:US
Practice Address - Phone:434-933-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16-204221700000X
VA0701010217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist