Provider Demographics
NPI:1194271213
Name:ADAMS, STACY MARIE (MS, AMFT)
Entity type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:CA
Mailing Address - Zip Code:93434-0963
Mailing Address - Country:US
Mailing Address - Phone:805-868-6951
Mailing Address - Fax:
Practice Address - Street 1:201 S MILLER ST STE 107
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5248
Practice Address - Country:US
Practice Address - Phone:805-868-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT117357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist