Provider Demographics
NPI:1275903593
Name:STAGER, DAIA G (LMSW # 10668)
Entity Type:Individual
Prefix:MS
First Name:DAIA
Middle Name:G
Last Name:STAGER
Suffix:
Gender:F
Credentials:LMSW # 10668
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7338
Mailing Address - Country:US
Mailing Address - Phone:423-223-6880
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST
Practice Address - Street 2:SUITE 425
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7556
Practice Address - Country:US
Practice Address - Phone:423-232-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
TN106681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health