Provider Demographics
NPI:1205369626
Name:ATHENS, STACY (LMSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ATHENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SHATTUCK RD
Mailing Address - Street 2:STE 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3157
Mailing Address - Country:US
Mailing Address - Phone:989-272-3727
Mailing Address - Fax:989-355-0447
Practice Address - Street 1:3400 SHATTUCK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3157
Practice Address - Country:US
Practice Address - Phone:989-272-3727
Practice Address - Fax:989-355-0447
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010918151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical