Provider Demographics
NPI:1518621879
Name:HALL, STACY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20211 AZTEC CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3381
Mailing Address - Country:US
Mailing Address - Phone:703-407-5844
Mailing Address - Fax:
Practice Address - Street 1:20211 AZTEC CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3381
Practice Address - Country:US
Practice Address - Phone:703-407-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health