STACEY WALLER PH.D.
NPI 1114990900
Psychologist - Clinical in Charleston, WV

Q: What is Stacey Waller's NPI number?

The NPI number for Stacey Waller is 1114990900. It was assigned to this individual provider in the NPPES registry on February 10, 2006.

Q: What is Stacey Waller's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Stacey Waller was last updated on June 4, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 10, 2006

1097 FLEDDERJOHN RD STE 3, CHARLESTON, WV 25314(304) 345-0880(304) 345-1112 Get Directions Write a Review

NPPES record last updated: June 4, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Stacey Waller Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACEY WALLER PH.D. (NPI 1114990900) is an individual clinical provider in Charleston, West Virginia, licensed in West Virginia (891) and active in the NPI registry since February 2006.

NPPES Registry Identity

NPI1114990900

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameSTACEY WALLERCredential: PH.D.

Location Address1097 FLEDDERJOHN RD STE 3Charleston, WV 25314-4208

Mailing Address1097 Fledderjohn Rd Ste 3Charleston, WV 25314-4208 · (304) 345-0880 · Fax (304) 345-1112

Phone(304) 345-0880

Fax(304) 345-1112

Sole ProprietorNo

Enumeration DateFebruary 10, 2006

Last NPPES UpdateJune 4, 2008

✔ NPI 1114990900 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in WV · 891

Definition

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.

1097 FLEDDERJOHN RD STE 3, Charleston, WV 25314

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Other Identifiers 3

Medicare UPINQ35571

Medicare ID-Type UnspecifiedWACP30781WV

Medicaid3810001772WV

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacey Waller's NPI number?

The NPI number for Stacey Waller is 1114990900. It was assigned to this individual provider in the NPPES registry on February 10, 2006.

Where is Stacey Waller located?

Stacey Waller practices at 1097 Fledderjohn Rd Ste 3, Charleston, WV 25314. The listed phone number is (304) 345-0880.

What is Stacey Waller's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Stacey Waller was last updated on June 4, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.