Provider Demographics
NPI:1336553023
Name:SEBASTIAN, STACIE (LPC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2530
Mailing Address - Country:US
Mailing Address - Phone:412-200-0791
Mailing Address - Fax:
Practice Address - Street 1:1840 MAYVIEW RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1590
Practice Address - Country:US
Practice Address - Phone:412-200-0791
Practice Address - Fax:412-831-8748
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional