Individual
CLINT JAY STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRSS-SUD
Contact information
Practice address
550 N EISENHOWER DR, BECKLEY, WV 25801-3109
(681) 323-8335
(681) 323-8335
Mailing address
PO BOX 464, PANTHER, WV 24872-0464
(681) 323-8335
(681) 323-8335
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-9156
WV
Other
Enumeration date
10/02/2025
Last updated
10/02/2025
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