Provider Demographics
NPI:1013602531
Name:SOWELL, STACY M (LPCA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:SOWELL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 AUTUMN HILL TRL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9468
Mailing Address - Country:US
Mailing Address - Phone:502-718-0559
Mailing Address - Fax:
Practice Address - Street 1:406 BLANKENBAKER PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1881
Practice Address - Country:US
Practice Address - Phone:502-749-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health