Provider Demographics
NPI:1265591093
Name:FLINT, STACY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:FLINT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:FLINT
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:594 MALOY DR
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24458-2200
Mailing Address - Country:US
Mailing Address - Phone:757-647-6638
Mailing Address - Fax:
Practice Address - Street 1:2000 DUKE ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-6101
Practice Address - Country:US
Practice Address - Phone:757-647-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046851041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1265591093Medicaid
VA010147514Medicaid