Provider Demographics
NPI:1942370911
Name:CRANDALL, STACEY LYNN (MS, NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:CROSCUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:140 FRONT ST.
Mailing Address - City:MT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349-0206
Mailing Address - Country:US
Mailing Address - Phone:304-777-8620
Mailing Address - Fax:
Practice Address - Street 1:202 COLUMBIA ST
Practice Address - Street 2:NEW BEGINNINGS
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4047
Practice Address - Country:US
Practice Address - Phone:304-367-1625
Practice Address - Fax:304-363-2282
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP54457101YM0800X
WV2072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health