Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 1062076 | KY |
NPI | 1003212531 |
---|---|
Provider Name | Stacy Stevens |
First Address | Ashland, KY 41105-0790 |
Second Address | Flatwoods, KY 41139-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2014 |
Last Update Date | 11/11/2014 |