Provider Demographics
NPI:1336447770
Name:LUCZEJKO, STACEY (EDS, MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LUCZEJKO
Suffix:
Gender:F
Credentials:EDS, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12022 CHANCELLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-1031
Mailing Address - Country:US
Mailing Address - Phone:215-586-0847
Mailing Address - Fax:
Practice Address - Street 1:12022 CHANCELLOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-1031
Practice Address - Country:US
Practice Address - Phone:215-586-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional