Provider Demographics
NPI:1962890707
Name:MARCH, STACIA
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:MARCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 MOUNTAIN LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7720
Mailing Address - Country:US
Mailing Address - Phone:334-669-3358
Mailing Address - Fax:
Practice Address - Street 1:1050 SHILOH RD NW
Practice Address - Street 2:SUITE 311
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7194
Practice Address - Country:US
Practice Address - Phone:334-669-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-01
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006411104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker