Provider Demographics
NPI:1235871682
Name:MCGHEE, STACIE DANIELLE (MACM, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:DANIELLE
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:MACM, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2006
Mailing Address - Country:US
Mailing Address - Phone:901-543-8586
Mailing Address - Fax:901-543-8599
Practice Address - Street 1:696 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2006
Practice Address - Country:US
Practice Address - Phone:901-543-8586
Practice Address - Fax:901-543-8599
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health