Most Relevant Information
Provider Data
| NPI Number: | 1003401670 |
| Provider Name: | ADRIAN LEE STACKHOUSE |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 25426 |
Most Important Dates
| Enumeration Date: | 03/05/2021 |
| Last Updated: | 03/05/2021 |
Provider Practice Location
9627 PHILADELPHIA RD STE 160
ROSEDALE
MD
212374157
Practice Location Phone/Fax
| Phone: | 4107805203 |
| Fax: |
Provider Mailing Location
9627 PHILADELPHIA RD STE 160
ROSEDALE
MD
212374157
Provider Mailing Phone/Fax
| Phone: | 4107805203 |
| Fax: |