Individual
JESSICA STALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1120 BYPASS RD, VINTON, VA 24179
(540) 767-2667
(540) 767-2669
Mailing address
1120 BYPASS RD, VINTON, VA 24179
(540) 767-2667
(540) 767-2669
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904008299
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437137734
—
VA
Enumeration date
08/07/2013
Last updated
11/11/2015
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