Provider Demographics
NPI:1063576387
Name:NAWN, STACIE A (LPC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:NAWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5300
Mailing Address - Country:US
Mailing Address - Phone:610-619-8732
Mailing Address - Fax:610-497-7420
Practice Address - Street 1:600 HAVERFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1139
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:484-413-2183
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional