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Stacy Vance
Mental Health Counselor in Centralia, Illinois
NPI 1144888710

Stacy Vance is a Mental Health Counselor based in Centralia, IL and is specialized in Mental Health. Stacy Vance practices in Centralia, IL. The NPI Number for Stacy Vance is 1144888710 and holds a License No. (Illinois).

The current practice location address for Stacy Vance is 904 E Mlk Drive, Centralia, IL and can be reached out via phone at 618-533-1391 and via fax at 618-533-0012.

Location: 904 E Mlk Drive, Centralia, IL, 62801
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1144888710
Provider Name
Stacy Vance
Credential
Provider Entity Type
Individual
Gender
Female
Address
904 E Mlk Drive, Centralia, IL, 62801
Phone Number
618-533-1391
Fax Number
618-533-0012
Provider Enumeration Date
05/30/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
370915481007 05 IL
institution
Provider Business Practice Location Address Details
Address
904 E Mlk Drive
City
Centralia
State
Illinois
Zip
62801
Phone Number
618-533-1391
Fax Number
618-533-0012
person
Provider Business Mailing Address Details
Address
904 E Mlk Drive
City
Centralia
State
Illinois
Zip
62801
Phone Number
618-533-1391
Fax Number
618-533-0012
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
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Definition
Definition to come...
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