Provider Demographics
NPI:1265849434
Name:WHITESIDE, STACI (MA, LPC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-8431
Mailing Address - Country:US
Mailing Address - Phone:985-774-7500
Mailing Address - Fax:
Practice Address - Street 1:441 HOLMES DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-8431
Practice Address - Country:US
Practice Address - Phone:985-774-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional