Provider Demographics
NPI:1447345749
Name:LILLEY, STACEY CUSTER (LPC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:CUSTER
Last Name:LILLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 ST. IVES COURT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-400-6898
Mailing Address - Fax:
Practice Address - Street 1:2965 COLONNADE DR SUITE 100
Practice Address - Street 2:BRALEY & THOMPSON, INC.
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-989-1703
Practice Address - Fax:540-989-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional