Provider Demographics
NPI:1891270161
Name:SALVO, STACIE MICHELLE (MA, ALC)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MICHELLE
Last Name:SALVO
Suffix:
Gender:F
Credentials:MA, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W BYRD ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36445-4474
Mailing Address - Country:US
Mailing Address - Phone:321-295-2939
Mailing Address - Fax:
Practice Address - Street 1:1848 DREWRY RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-5856
Practice Address - Country:US
Practice Address - Phone:251-298-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3162A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health