Provider Demographics
NPI:1942363643
Name:STALLINGS, ROXANNE FEAGLER (MFT)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:FEAGLER
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801
Mailing Address - Country:US
Mailing Address - Phone:510-234-8734
Mailing Address - Fax:510-234-8734
Practice Address - Street 1:11100 SAN PABLO AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2194
Practice Address - Country:US
Practice Address - Phone:510-234-8734
Practice Address - Fax:510-234-8734
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health