Provider Demographics
NPI:1700323276
Name:WARD, STACIE (LCSW, MS)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 NANTICOKE CIR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-8641
Mailing Address - Country:US
Mailing Address - Phone:302-536-9317
Mailing Address - Fax:302-990-5376
Practice Address - Street 1:9707 NANTICOKE CIR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-8641
Practice Address - Country:US
Practice Address - Phone:302-536-9317
Practice Address - Fax:302-990-5376
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0001251101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1477981629OtherORGANIZATION NPI
DE2016606905OtherBUSINESS LICENSE