Basic Information
| Provider Information | |||||||||
| NPI: | 1033509898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 252 COURTHOUSE DRIVE | ||||||||
| Address2: | PRESTERA CEBTER | ||||||||
| City: | WINFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252139370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045257851 | ||||||||
| FaxNumber: | 3045860671 | ||||||||
| Practice Location | |||||||||
| Address1: | 3375 US RT 60 | ||||||||
| Address2: | PRESTERA CENTER | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045257851 | ||||||||
| FaxNumber: | 3045860671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2015 | ||||||||
| LastUpdateDate: | 02/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | BP00944523 | WV | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0005355002 | 05 | WV | MEDICAID |