Provider Demographics
NPI:1942849864
Name:RUSH, STACY M (LCMHC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:RUSH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 TAYLOR POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-7732
Mailing Address - Country:US
Mailing Address - Phone:252-200-3562
Mailing Address - Fax:
Practice Address - Street 1:120 CYPRESS LANDING DR
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-2500
Practice Address - Country:US
Practice Address - Phone:808-726-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health