Provider Demographics
NPI:1578069506
Name:GRIFFITH, STACEY (LCPC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:GRIFFITH
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 1:3205 N WILKE RD STE 102C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-0004
Mailing Address - Country:US
Mailing Address - Phone:224-349-2594
Mailing Address - Fax:224-850-3500
Practice Address - Street 1:3205 N WILKE RD STE 102C
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-0004
Practice Address - Country:US
Practice Address - Phone:224-349-2594
Practice Address - Fax:224-850-3500
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012424101Y00000X
IL180.012687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178012424OtherLICENSE
WI8089-125OtherWI LICENSE
IL180.012687OtherLICENSE