Provider Demographics
NPI:1144479379
Name:YOUNG, STACI M (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACI
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:TROMBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4162
Mailing Address - Country:US
Mailing Address - Phone:804-693-5068
Mailing Address - Fax:804-693-7407
Practice Address - Street 1:7025 HARBOUR VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2761
Practice Address - Country:US
Practice Address - Phone:757-434-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0497717615OtherVA PREMIER MEDICAID HMO
VA294721OtherVALUE OPTIONS
VA1497717615Medicaid