Provider Demographics
NPI:1326729435
Name:GILMER, STACEY MILLIE (CLINICIAN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MILLIE
Last Name:GILMER
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MILLIE
Other - Last Name:PAPADEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1837
Mailing Address - Country:US
Mailing Address - Phone:386-316-0187
Mailing Address - Fax:
Practice Address - Street 1:435 S RIDGEWOOD AVE STE 204C-205
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4927
Practice Address - Country:US
Practice Address - Phone:386-747-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist