Provider Demographics
NPI:1932550399
Name:SUFKA, STACY SYDNEY (LICDC, GAMB)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:SYDNEY
Last Name:SUFKA
Suffix:
Gender:F
Credentials:LICDC, GAMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 214TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1953
Mailing Address - Country:US
Mailing Address - Phone:216-551-3047
Mailing Address - Fax:
Practice Address - Street 1:400 E 214TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1953
Practice Address - Country:US
Practice Address - Phone:216-551-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141079-3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)