Provider Demographics
NPI:1730301987
Name:DARAGO, STACEY LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:LYNN
Last Name:DARAGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNNE
Other - Last Name:GAUDIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 WASHINGTON STREET
Mailing Address - Street 2:SUITE A 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8567
Mailing Address - Country:US
Mailing Address - Phone:770-287-1356
Mailing Address - Fax:770-287-1352
Practice Address - Street 1:621 WASHINGTON STREET
Practice Address - Street 2:SUITE A 2
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8567
Practice Address - Country:US
Practice Address - Phone:770-287-1356
Practice Address - Fax:770-287-1352
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional