STACEY WALLER PH.D. NPI 1114990900

NPI Information

  • NPI: 1114990900
  • Provider Name: STACEY WALLER, PH.D.
  • Classification: Psychologist - 103TC0700X
  • Specialization: Clinical
  • Entity Type: Individual
  • Address: 1097 FLEDDERJOHN RD STE 3
    CHARLESTON, WV
    ZIP 25314
  • Phone: (304) 345-0880

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NPI Details

Stacey Waller, PH.D. is a clinical psychologist in Charleston, WV. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. Stacey Waller, PH.D. NPI is 1114990900. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1097 FLEDDERJOHN RD STE 3
CHARLESTON, WV
ZIP 25314-208
Phone: (304) 345-0880
Fax: (304) 345-1112

The enumeration date for this NPI number is 2/10/2006 and was last updated on 6/4/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinical891WEST VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1Q35571MEDICARE UPIN
2WACP30781MEDICARE ID-TYPE UNSPECIFIEDWEST VIRGINIA
33810001772MEDICAIDWEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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