Provider Demographics
NPI:1346620663
Name:HALL, STACEY (LCPC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4414
Mailing Address - Country:US
Mailing Address - Phone:609-691-9579
Mailing Address - Fax:
Practice Address - Street 1:39 MECHANIC ST
Practice Address - Street 2:SUITE 222
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1807
Practice Address - Country:US
Practice Address - Phone:207-691-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health