Provider Demographics
NPI:1982892113
Name:LACROIX, STEPHANIE JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JILL
Last Name:LACROIX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 N 25TH ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6539
Mailing Address - Country:US
Mailing Address - Phone:804-643-0002
Mailing Address - Fax:804-643-3106
Practice Address - Street 1:719 N 25TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6539
Practice Address - Country:US
Practice Address - Phone:804-643-0002
Practice Address - Fax:804-643-3106
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical