Provider Demographics
NPI:1336369024
Name:GOOLSBY, STACY KATHLEEN (CAS 2)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:KATHLEEN
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:CAS 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 KINGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1828 TRIBUTE RD
Practice Address - Street 2:SUITE H
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4310
Practice Address - Country:US
Practice Address - Phone:916-564-4400
Practice Address - Fax:916-564-4424
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)