Provider Demographics
NPI:1932796158
Name:STANLEY, JAMIE (BSW, LSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0835
Mailing Address - Country:US
Mailing Address - Phone:304-294-5610
Mailing Address - Fax:
Practice Address - Street 1:3776 MOUNTAINEER HIGHWAY
Practice Address - Street 2:
Practice Address - City:MABEN
Practice Address - State:WV
Practice Address - Zip Code:25870
Practice Address - Country:US
Practice Address - Phone:304-294-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00941288171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator