Provider Demographics
NPI:1619664265
Name:DUBOIS, STACY LYNN (MA, LLPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-8522
Mailing Address - Country:US
Mailing Address - Phone:269-254-6542
Mailing Address - Fax:
Practice Address - Street 1:1904 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-8522
Practice Address - Country:US
Practice Address - Phone:269-254-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health