Individual
KATHLEEN MARIE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
576 JEFFERSON AVE, MCDONALD ARMY HEALTH CENTER, FT EUSTIS, VA 23604-5548
(757) 344-6921
Mailing address
576 JEFFERSON AVE, MCDONALD ARMY HEALTH CENTER, FT EUSTIS, VA 23604-5548
(757) 344-6921
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101044295
VA
2084P0802X
Addiction Psychiatry Physician
0101044295
VA
Other
Enumeration date
03/24/2006
Last updated
01/10/2013
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