Provider Demographics
NPI:1043722382
Name:ADAMS, STACEY LYNN (BA, CDCA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:BA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 JACKSON PIKE
Mailing Address - Street 2:PO BOX 88
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-0088
Mailing Address - Country:US
Mailing Address - Phone:740-992-3965
Mailing Address - Fax:
Practice Address - Street 1:788 N 2ND AVE STE A
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760-1014
Practice Address - Country:US
Practice Address - Phone:740-992-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)