Provider Demographics
NPI:1194943043
Name:STAHL, ADRIENNE WEAVER (CRC, QRP)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:WEAVER
Last Name:STAHL
Suffix:
Gender:F
Credentials:CRC, QRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 VENTURE DR # 216
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-7306
Mailing Address - Country:US
Mailing Address - Phone:304-904-7267
Mailing Address - Fax:304-292-1890
Practice Address - Street 1:714 VENTURE DR # 216
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-7306
Practice Address - Country:US
Practice Address - Phone:304-904-7267
Practice Address - Fax:304-292-1890
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVQRP00000264171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQRP00000264OtherQUALIFIED REHABILITATION
ILC-043170OtherCERTIF. REHAB. COUNSELOR