Provider Demographics
NPI:1982958344
Name:WOOD, STACEY G (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:G
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:G
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC-CC
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0906
Mailing Address - Country:US
Mailing Address - Phone:207-266-9013
Mailing Address - Fax:
Practice Address - Street 1:415 WATER ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2116
Practice Address - Country:US
Practice Address - Phone:207-610-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional