Provider Demographics
NPI:1902040249
Name:DEWOLFE, STACIE RENEE (LGSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:RENEE
Last Name:DEWOLFE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:BATEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-3203
Mailing Address - Fax:256-582-3216
Practice Address - Street 1:2409 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:575-393-3168
Practice Address - Fax:575-937-4659
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0120951101YA0400X
NMX-06231104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker