Provider Demographics
NPI:1790110781
Name:BABB, STACY CHARLENE (LMT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:CHARLENE
Last Name:BABB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-3304
Mailing Address - Country:US
Mailing Address - Phone:864-434-6141
Mailing Address - Fax:
Practice Address - Street 1:3795 EAST NORTH SUITE 14
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-3304
Practice Address - Country:US
Practice Address - Phone:864-434-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist