Provider Demographics
NPI:1629248760
Name:CRETZMEYER, STACY MEGAN (PHD NCC LPC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MEGAN
Last Name:CRETZMEYER
Suffix:
Gender:F
Credentials:PHD NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2913
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-357-8577
Mailing Address - Fax:843-357-4962
Practice Address - Street 1:641 LITTLE TONY AVENUE
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-357-8577
Practice Address - Fax:843-357-4962
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional