Provider Demographics
NPI:1245693357
Name:THAXTON, STACIE (LPCC, NCC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:THAXTON
Suffix:
Gender:F
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0481
Mailing Address - Country:US
Mailing Address - Phone:740-587-5252
Mailing Address - Fax:740-587-2571
Practice Address - Street 1:945 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9534
Practice Address - Country:US
Practice Address - Phone:740-587-5252
Practice Address - Fax:740-587-2571
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1400025101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health