Provider Demographics
NPI:1902230980
Name:STANLEY, MINDY SUE (LPC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:SUE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:SUE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:312 6TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1265
Mailing Address - Country:US
Mailing Address - Phone:304-768-6170
Mailing Address - Fax:304-768-2099
Practice Address - Street 1:312 6TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1265
Practice Address - Country:US
Practice Address - Phone:304-768-6170
Practice Address - Fax:304-768-2099
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1637225C00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor