Provider Demographics
NPI:1750827275
Name:STACY, JODY (MDIV)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:STACY
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 N MAGNOLIA AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-5125
Mailing Address - Country:US
Mailing Address - Phone:855-572-2329
Mailing Address - Fax:
Practice Address - Street 1:923 N MAGNOLIA AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-5125
Practice Address - Country:US
Practice Address - Phone:855-572-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral