Provider Demographics
NPI:1174547962
Name:STOKES, MALCOLM A (PHD, ACSW)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:A
Last Name:STOKES
Suffix:
Gender:M
Credentials:PHD, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-0341
Mailing Address - Country:US
Mailing Address - Phone:937-592-9545
Mailing Address - Fax:937-592-9790
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1617
Practice Address - Country:US
Practice Address - Phone:937-592-9545
Practice Address - Fax:937-592-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSTSW10391OtherRAILROAD MEDICARE
OH000000001267OtherANTHEM
OH000000001267OtherANTHEM
OHSTSW10391OtherRAILROAD MEDICARE