Provider Demographics
NPI:1033539093
Name:FROELICH, STACY W (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:W
Last Name:FROELICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 COOPER RD STE A
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2579
Mailing Address - Country:US
Mailing Address - Phone:678-643-6782
Mailing Address - Fax:770-962-0088
Practice Address - Street 1:299 COOPER RD STE A
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2579
Practice Address - Country:US
Practice Address - Phone:678-643-6782
Practice Address - Fax:770-962-0088
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW006215101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor