Provider Demographics
NPI:1831862655
Name:LALEAU, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LALEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4006 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3531
Mailing Address - Country:US
Mailing Address - Phone:404-960-1282
Mailing Address - Fax:
Practice Address - Street 1:420 THOMASTON ST
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295-3387
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007353104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker