Provider Demographics
NPI:1891126835
Name:MEACHAM, STACIE (LMHC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33A HARVARD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7989
Mailing Address - Country:US
Mailing Address - Phone:781-249-7069
Mailing Address - Fax:
Practice Address - Street 1:33A HARVARD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7989
Practice Address - Country:US
Practice Address - Phone:781-249-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health