Provider Demographics
NPI:1932751591
Name:HAFFERMAN, STACI KRISTINE (LPC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:KRISTINE
Last Name:HAFFERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:KRISTINE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4141 B ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5941
Mailing Address - Country:US
Mailing Address - Phone:907-343-9776
Mailing Address - Fax:
Practice Address - Street 1:4141 B ST STE 301
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5941
Practice Address - Country:US
Practice Address - Phone:907-343-9776
Practice Address - Fax:907-561-0025
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional