Provider Demographics
NPI:1629745120
Name:FEKKERS, STACY NICOLLE (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:NICOLLE
Last Name:FEKKERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PRENTICE DR STE A
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-5002
Mailing Address - Country:US
Mailing Address - Phone:707-473-8445
Mailing Address - Fax:707-473-8451
Practice Address - Street 1:1310 PRENTICE DR STE A
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-5002
Practice Address - Country:US
Practice Address - Phone:707-473-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical